Tricuspid regurgitation: on CTPA
Patient presents with severe tricuspid regurgitation/incompetence on echocardigraphy. CTPA to assess for pulmonary embolism
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IV contrast injection form the right arm has enetered a dilated right atrium and then refluxed into the IVC and dilated heptic veins (arrows) as well as the dilated coronary sinus (arrow). No pulmonary embolism.
Incompetence at the tricuspid valve has allowed (contrast) opacified blood, that has passed from the right atrium into the right ventricle, to reflux back into the IVC and hepatic veins as well as the coronary sinus i.e. venous structures that communicate with the right atrium that should only contain unopacified blood. This is the radiological (CT) equivalent of the clinical pulsatile liver seen in tricuspid regurgitation.