Cardiovascular manifestations of ankylosing spondylitis may affect around 2-10% of all patients with ankylosing spondylitis. Cardiac complications include:
left ventricular dysfunction: considered on of the commonest findings 3
aortic root dilatation: also a relatively frequent finding 3
Cardiovascular (cardiac) shunts are abnormal connections between the pulmonary and systemic circulations. Most commonly they are the result of congenital heart disease.
Blood can either be shunted from the systemic circulation to pulmonary circulation (i.e. 'left-to-right shunt') or ...
Carotid pacemakers, also known as implantable carotid sinus stimulators, are devices that deliver activation energy, via carotid leads, to the carotid baroreceptors. This is sometimes offered for drug-resistant hypertension. The baroreceptors send signals to the brain and the signals are interpr...
The Carpentier classification divides mitral valve regurgitation into three types based on leaflet motion 1:
type I: normal leaflet motion
annular dilation, leaflet perforation
regurgitation jet directed centrally
type II: excessive leaflet motion
papillary muscle rupture, chordal rupture, ...
Pulseless electrical activity is a very disconcerting emergency medical scenario with a very high mortality unless its etiology can be quickly ascertained and corrected. A mnemonic to remember the different causes of pulseless electrical activity is:
MAD (triple H) CAT
M: massive pul...
Cervical aortic arches are a rare aortic arch anomaly characterized by an elongated, high-lying aortic arch extending at or above the level of the medial ends of the clavicles.
Patients with cervical aortic arch are usually asymptomatic. Symptomatic patients may present w...
Chagas disease, also known as American trypanosomiasis (plural: trypanosomiases), is a tropical parasitic infection with a wide spectrum of clinical manifestations since it can virtually affect any organ, but there are characteristic radiological features.
Chagas disease is endemi...
Chen sign on chest radiography is the prominence of left basal pulmonary vasculature compared the right base seen in valvular pulmonary stenosis. It is due to the asymmetric increase in pulmonary blood flow to the left lung due to preferential blood flow into the left pulmonary artery after pass...
This is a basic article for medical students and other non-radiologists
Chest x-ray review is a key competency for medical students, junior doctors and other allied health professionals. Using A, B, C, D, E is a helpful and systematic method for chest x-ray review where C refers to circulation ...
This is a basic article for medical students and other non-radiologists
Chest x-rays are performed frequently in the assessment of a vast number of sick (and potentially very sick) patients.
A chest x-ray can be performed in the radiology department (usually with the patient standing up) or b...
An uncommon anatomic variant present in the right atrium, a Chiari network refers to a filamentous, weblike structure that results from incomplete resorption of the embryologic sinus venosus.
Prevalence estimates for the general population vary widely, ranging from 2% - 10% of ran...
The chordae tendineae (singular: chorda tendinea, is rarely used) are thin strong inelastic fibrous cords that extend from the free edge of the cusps of the atrioventricular valves (the tricuspid and mitral valves) to the apices of the papillary muscles within the right and left ventricles respe...
Chronic thromboembolic pulmonary hypertension (CTEPH) is a distinct subgroup of pulmonary hypertension that most frequently develops following massive or repeated pulmonary embolism.
The term CTEPH should be used for patients with chronic thromboembolic disease and pulmonary hypert...
The circumflex artery (Cx) is one of the two major coronary arteries that arise from the bifurcation of the left main coronary artery (the other branch being the left anterior descending (LAD) artery).
The circumflex artery can be referred to by multiple terms:
circumflex artery (...
Coaptation refers to a joining or reuniting of two surfaces. This can be in the setting of ends of a broken bone or the edges of a wound or edges of a valve.
There are several described cockade signs in radiology:
cockade sign (intraosseous lipoma)
cockade sign (aorto-left ventricular tunnel) 1
cockade sign (appendicitis) 2
cockade sign (hypertrophic pyloric stenosis) 3
cockade sign (GI tumors) 4
COL4A1-related disorders are a group of autosomal dominant disorders caused by a mutation in the COL4A1 gene.
The exact prevalence is unknown, but the group of disorders is considered to be under-recognized, especially asymptomatic variants 1.
The clinical ...
Congenital aortic stenosis broadly refers to a congenital narrowing of the aortic lumen. Although the term can mean narrowing at any point, it often relates to a narrowing of the aortic valve. As a broad group, there can be some overlap with ascending aortic coarctation depending on the definiti...
Congenital cardiovascular anomalies are relatively common, with an incidence of up to 1% if small muscular VSDs are included. As a group, there is a much greater frequency in syndromic infants and in those that are stillborn.
Broadly, congenital cardiovascular anomalies ...
Congenital coronary artery anomalies (CCAAs) are not common, found only in ~1% (range 0.1-2%) of patients 1,3.The most important finding to look for is the "malignant" course of anomalous coronary artery, i.e. does the artery run between big pulsating objects - right ventricular outflow tract / ...
With the advent of echocardiography, and cardiac CT and MRI, the role of chest x-rays in evaluating congenital heart disease has been largely been relegated to one of historical and academic interest, although they continue to crop up in radiology exams. In most instances a definite diagnosis ca...
The diagnosis of congenital heart disease in echocardiography is outside the scope of basic echocardiography, however, several common features may be recognized at the point of care which allow for initial stablization and management before a complete echocardiography exam may be performed.
Congenitally corrected transposition of the great arteries, also known as levo- or L-loop transposition (L-TGA), is a rare cardiovascular anomaly with inversion of the ventricles and great arteries.
This anomaly comprises less than 1% of all congenital heart diseases 1,2,7.
Congenital pulmonary stenosis (CPS) refers to congenital narrowing of the right ventricular outflow tract, pulmonary valve or pulmonary artery.
See pulmonary valve stenosis for a general discussion about this valvulopathy.
The estimated incidence is 1 in 2000 births.
Congenital pulmonary venolobar syndrome is a condition comprising a rare group of cardiac and pulmonary congenital abnormalities occurring variably in combination. The abnormalities include:
anomalous pulmonary venous drainage
particularly scimitar syndrome with hypogenetic right lung
Congestive cardiac failure (CCF), also known as congestive heart failure (CHF) or simply heart failure, refers to the clinical syndrome caused by inherited or acquired abnormalities of heart structure and function, causing a constellation of symptoms and signs that lead to decreased quality and ...
Conotruncal heart defects are a group of congenital cardiovascular anomalies. They are a leading cause symptomatic cyanotic cardiac disease diagnosed in utero.
They may account for up to a fifth of all congenital cardiac anomalies diagnosed prenatally 2.
Constrictive pericardial syndromes include 1:
transient constrictive pericarditis
a complication of acute (inflammatory) pericarditis in which the inflamed pericardium causes constrictive hemodynamics
resolution occurs within several weeks
chronic constrictive pericarditis
persistence of c...
Constrictive pericarditis (or perhaps better termed pericardial constriction) is a type of pericarditis which leads to diastolic dysfunction and potentially symptoms of right heart failure.
No single demographic is affected as there are numerous causes of constrictive pericarditi...
The conus artery is a small early branch off the right coronary artery (RCA) circulation.
The artery has a variable distribution, but usually supplies a region of the anterior interventricular septum and the conus of the main pulmonary artery (hence its name).
Coronary arterial dominance is defined by the vessel which gives rise to the posterior descending artery (PDA), which supplies the myocardium of the inferior 1/3rd of the interventricular septum.
Most hearts (80-85%) are right dominant where the PDA is supplied by the RCA. The remaining 15-20% ...
Coronary arterial ectasia (CAE) refers to diffuse dilatation of the coronary arteries. Under some classification systems, there is some overlap with the term coronary arterial aneurysms (which is a more focal dilatation).
It is often defined as dilatation of an arterial segment to ...
The coronary arteries arise from the coronary sinuses immediately distal (superior) to the aortic valve and supply the myocardium with oxygenated blood. They branch and encircle the heart to cover its surface with a lacy network, perhaps resembling a slightly crooked crown.
Coronary arteriovenous fistulas (CAVFs) are rare coronary artery anomalies whereby there is a fistula between a coronary artery and, most commonly, the right side of the cardiac circulation.
Although a CAVF, in the strictest sense of the term, implies a communication between the c...
Coronary artery aneurysms are an uncommon, predominantly incidental finding.
Coronary artery aneurysms are most common in men 3, likely reflecting the increased rates of atherosclerosis in men compared to women. Prevalence varies in the literature between 0.1-5% 4.
A coronary artery bypass graft (CABG or CAG) is placed during a surgical procedure to increase blood flow to the myocardium due to coronary stenoses, usually caused by coronary artery disease. Arteries or veins can be grafted during this procedure.
Long term outcome of coronary artery bypass gr...
Coronary artery calcification is a common incidental finding in asymptomatic patients having CT of the thorax for non-cardiac indications as well as being a significant finding on cardiac CT. Coronary artery calcification is a marker of atherosclerotic plaque and thus coronary artery disease ris...
Coronary Artery Calcium Data and Reporting System (CAC-DRS) is a structured reporting scheme for all non-contrast CT scans in the evaluation of coronary artery disease, which can help in communication between clinicians and radiologists. These guidelines have been recommended by the Society of C...
Coronary artery disease (CAD) is the leading cause of mortality globally.
CAD is asymptomatic in most of the population. When severe enough it can cause angina or an acute coronary syndrome including myocardial infarction. CAD may also present with heart failure or sudde...
The Coronary Artery Disease - Reporting and Data System (CAD-RADS) is a standardized findings communication method and clinical decision aid relevant to coronary CT angiography. The system was created by a collaboration of the Society for Cardiovascular Computed Tomography (SCCT), American Colle...
Coronary artery dissection (also known as spontaneous coronary artery dissection or SCAD) is a rare cause of acute coronary syndrome especially in young patients who are otherwise healthy.
Coronary artery dissection occurs mainly in young, otherwise health patients especially in f...
Microvascular obstruction (MVO), also known as no reflow phenomenon, is an established complication encountered in coronary angioplasty for prolonged acute myocardial infarction.
The phenomenon results from obstruction of the myocardial microcirculation, which is composed of vessel...
Coronary MR angiography (coronary MRA) is a developing approach to imaging the coronary arteries.
Advantages of coronary MRA include avoidance of the intravenous iodinated contrast and ionizing radiation used in coronary CT angiography and conventional angiography.
A disadvantage of coronary M...
A coronary ostial dimple is a type of congenital coronary artery anomaly where there is a rudiment of the coronary ostium usually followed more distally by proximal coronary stem atresia.
The coronary sinus is the largest cardiac venous structure. It returns the majority of the blood supply for the left ventricle to the right atrium.
The coronary sinus courses along the posterior wall of the left atrium into the left atrioventricular groove. It normally drains int...
The coronary veins return deoxygenated blood from the myocardium back to the right atrium. Most venous blood returns via the coronary sinus. Coronary venous anatomy is highly variable, but is generally comprised of three groups:
cardiac veins which drain into the coronary sinus:
great cardiac ...
Cor pulmonale is defined as a failure of the structure and function of the right ventricle in the absence of left ventricular dysfunction. It is caused by an underlying primary disorder of the respiratory system. It has a generally chronic and slowly progressive course, although acute onset or w...
Cor triatriatum is an extremely rare and serious congenital cardiac anomaly.
It is thought to account for ~0.1% of all congenital cardiac anomalies 3,4.
Clinical presentation depends on:
degree of stenosis in the fibromuscular membrane
the integrity of ...
A coumadin ridge, also called warfarin ridge or left lateral ridge, is a band-like embryological remnant in the left atrium between the left superior pulmonary vein and the left atrial appendage. It is considered an anatomical variant.
The ridge is formed by the coalition of the left superior ...
Creatine kinase (CK), also known as creatine phosphokinase (CPK), is a key enzyme, for energy production in mitochondria and muscle tissues. It is important as a diagnostic assay in clinical practice, primarily because inflamed/injured muscle releases creatine kinase into the circulation 1.
The crista terminalis is a smooth muscular ridge in the superior aspect of the right atrium, formed following resorption of the right valve of the sinus venosus. It represents the junction between the sinus venarum, the "smooth" portion of the right atrium derived from the embryologic sinus veno...
A crus (plural: crura) is an anatomical term used for a structure which resembles a leg.
crus (internal capsule)
crus (semicircular duct)
This is a basic article for medical students and other non-radiologists
Chest CT is a computed tomography examination of the thoracic cavity performed for a variety of reasons, from suspected cancer to penetrating chest trauma.
A CT chest can be performed with or without IV contrast and when I...
A number of entities can present as cyanotic congenital heart disease. These can be divided into those with increased (pulmonary plethora) or decreased pulmonary vascularity :
increased pulmonary vascularity
total anomalous pulmonary venous return (TAPVR) (types I and II)
transposition of the...
Danon disease is an X-linked dominant cause of debilitating cardioskeletal myopathy and is a lysosomal storage disorder.
Although considered rare, the exact incidence is unknown 1.
Danon disease is characterized by the triad of 1-4:
Deductive echocardiography is a step-by-step approach in diagnosing and differentiating congenital heart disease.
position of heart
Delayed myocardial enhancement, as seen on cardiac MRI, occurs when gadolinium contrast material seeps into fibrotic or necrotic myocardial tissue. It is due to a number of etiologies, and has variable appearances.
subendocardial enhancement indicates an ischemic etiology
Delayed myocardial enhancement can occur in cardiac MR assessment due to a number of causes.
myocardial ischemia: typically subendocardial and follows a vascular territory 1
non-ischemic dilated cardiomyopathy
Atrial situs refers to the relative position of the cardiac atria in relation to abdominal viscera and the midline.
Identification of atrial situs is an important initial step in the antenatal and postnatal diagnosis of cardiac structural and situs anomalies.
An electrocardiographic finding suggestive of impending myocardial infarction, the de Winter's pattern (or "de Winter's T-waves") describes an abnormality thought to be indicative of acute occlusion of the proximal left anterior descending coronary artery (LAD) 2. Timely recognition of this patt...
Dextrocardia is a congenital cardiac malrotation in which the heart is situated on the right side of the body (dextroversion) with the apex pointing to the right.
Dextrocardia merely refers to the laterality of the heart, it says nothing about the orientation of the patient's other...
Diagonal branches of the left anterior descending coronary artery supply blood flow to the anterior and anterolateral walls of the left ventricle. There are usually denoted as D1, D2, D3, etc.
There are termed "diagonal" due to them branching from their parent vessel at acute angles. They ext...
Assessment for diastolic dysfunction is an advanced application of point-of-care ultrasonography, most commonly used as a supplemental non-invasive estimate of left atrial pressure in hemodynamically complex patients 1. Of note, this article will discuss the simplified, binary approach used in c...
Diastolic pseudogating appears as periodic bright and dark signal in arteries such as the aorta as one progresses through a series of images. Synchronization of the cardiac cycle and the pulse sequence results in high signal in the artery during diastole when blood is relatively stationary and l...
A small cardiothoracic ratio (CTR) is defined as <42%/0.42 when assessed on a PA chest radiograph, and is often called small heart syndrome. A pathologically-small heart is also known as microcardia.It can be due to/associated with a number of entities:
adrenal insufficiency, e.g. Addison disea...
Dilated cardiomyopathy (DCM) is defined as left ventricular chamber dilation with decreased systolic function (FEVG <40%) in the absence of coronary artery disease or conditions which impose a chronic pressure overload. There may also be right ventricular dysfunction. Causes are related to intri...
The double density sign can refer to several radiological signs:
double density sign (left atrial enlargement)
double density sign (berry aneurysm)
double density sign (osteoid osteoma)
The double-density sign, also known as the double right heart border, is seen on frontal chest radiographs in the presence of left atrial enlargement, and occurs when the right side of the left atrium pushes behind the right cardiac shadow, indenting the adjacent lung and forming its own distinc...
The double density sign, also sometimes clumsily referred to as the hotter spot within hot area sign, is a bone scan sign of an osteoid osteoma.
It refers to a central focus of intense uptake (the nidus) within a surrounding lower, but nonetheless increased uptake, rim.
Double oblique is a type of multiplanar reconstruction used in cardiac cross-sectional imaging. It is useful for an accurate assessment of the ascending aorta and aortic annulus, and is particularly useful for pre- and post-procedure evaluation of a transcatheter aortic valve replacement (TAVR)....
Double outlet left ventricle (DOLV) is an extremely rare congenital cardiac anomaly where both the aorta and pulmonary trunk arise from the anatomical left ventricle. It is usually classified as a conotruncal anomaly and is often associated with a ventricular septal defect with normal continuity...
Double outlet right ventricle (DORV) is a congenital cardiac anomaly where both the aorta and pulmonary trunk arise from the morphologically right ventricle. It is reported to account for ~2% of congenital cardiac defects 1. It is usually classed as a conotruncal anomaly. There is almost always ...
The double switch procedure is a surgical technique used to repair congenitally corrected transposition of the great arteries (L-TGA), which is a cardiovascular anomaly with atrioventricular and ventriculoarterial discordance.
The procedure consists of any of the following surgical combinations...
Down syndrome (or trisomy 21) is the most common trisomy and also the commonest chromosomal disorder. It is a major cause of intellectual disability, and also has numerous multisystem manifestations.
According to the World Health Organization (WHO), the approximate worldwide incid...
Dressler syndrome (DS) is a delayed immune-mediated or secondary pericarditis developing weeks to months after a myocardial infarction (MI).
Dressler syndrome is not to be confused with pericarditis epistenocardica (which is seen earlier in the post-MI period) and is considered a r...
Drug and toxin induced pulmonary hypertension is one of the causes of pulmonary arterial hypertension. It falls under group 1.3 under the Dana point classification system of pulmonary hypertension.
A wide range of difference drugs have been associated with developing pulmonary hyper...
D-SPECT represents the next step in the evolution of SPECT technology and is based on a unique acquisition geometry. It has nine arrays of cadmium zinc telluride (CZT) detectors, each of which rotates around its central axis with programmable angular rotation 1. The detectors are very compact al...
A dual left anterior descending coronary arteries are a group of rare variants of the left anterior descending artery. Almost all dual variants have short and long LAD branches.
Several (up to 9) subtypes have been described including the 4 initial types originally described by Spindo...
Duchenne muscular dystrophy (DMD) is a dystrophinopathy and the most common muscular dystrophy.
DMD has an incidence of 1 in 3500 to 5000 males 1,2. The condition is extremely rare in females due to its inheritance pattern, as discussed below 1.
The ductus arteriosum (DA) (or arteriosus) is the thick short conduit for blood to bypass the non-ventilated lungs in the fetus. It is located between and connects the proximal left pulmonary artery and the undersurface of the aortic arch distal to the origin of the last branch of the arch, at t...
The Duke criteria are a set of clinical criteria set forward for the diagnosis of infective endocarditis
For diagnosis the requirement is:
2 major and 1 minor criteria or
1 major and 3 minor criteria or
5 minor criteria
For adequate diagnostic sensitivity, transesophageal echocardiography ...
Dysphagia megalatriensis, also known as cardiovascular dysphagia or cardiac dysphagia, is an impairment of swallowing due to esophageal compression from a dilated left atrium.
Presentation is generally with mild dysphagia, although a minority of patients will have dyspha...
The earth-heart sign is a newly recognized sign of cardiac compromise that may be seen on chest radiographs of patients with tension pneumomediastinum.
The substantial pressure exerted on the heart by the gas trapped in the mediastinum with subsequent impairment of central venous return and obs...
Ebstein anomaly is an uncommon congenital cardiac anomaly, characterized by a variable developmental anomaly of the tricuspid valve.
The anomaly accounts for only ~0.5% of congenital cardiac defects 6,7, although it is the most common cause of congenital tricuspid regurgitation. T...
Echogenic intracardiac focus (EIF) is a relatively common sonographic observation that may be present on an antenatal ultrasound scan.
They are thought to be present in ~4-5% of karyotypically normal fetuses. They may be more common in the Asian population 5.
Ectopia cordis is an extremely rare congenital malformation where the heart is located partially or totally outside the thoracic cavity. The four main ectopic positions are:
adjacent to the thorax: ~60%
The incidence is ...
Effusive-constrictive pericarditis is a rare constrictive pericardial syndrome of a constellation of findings in which a fibrotic visceral pericardium and a pericardial effusion contribute to cardiac tamponade pathophysiology. It is most often encountered after the performance of a pericardiocen...
Egg-on-a-string sign, also referred to as egg on its side, refers to the cardiomediastinal silhouette seen in transposition of the great arteries (TGA).
The heart appears globular due to an abnormal convexity of the right atrial border and left atrial enlargement and therefore appears like an ...
Eisenmenger complex is a specific subset of Eisenmenger syndrome, and consists of:
ventricular septal defect (VSD)
severe pulmonary arterial hypertension resulting in
shunt reversal and cyanosis
The Elliott et al. classification system of cardiomyopathies is one of the cardiomyopathy classification systems. This was published by the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. This places emphasis on phenotypic classification 1-2.
Endocardial fibroelastosis (EFE) is a rare cardiac condition which is classically described in the pediatric population (typically first two years). It is one of the causes for infants to present with unexplained heart failure.
The condition results from increasing amounts of fibrou...
Endomyocardial fibrosis (EMF) is an idiopathic disorder characterized by the development of restrictive cardiomyopathy.
It usually occurs in tropical and subtropical regions of the world.There may be a greater predilection in children and adolescents.
It can occur ...
An enlarged/dilated azygos vein may result from a number of physiological as well as pathological causes. The enlarged azygos vein may be seen as a widened right paratracheal/paraspinal stripe on a frontal chest radiograph.
Spelling it "azygous" when referring to the vein is incorr...