Mitral valve calcification can refer to 1
mitral annular calcification (MAC) or
mitral valve leaflet calcification (MVL)
Mitral valve disease (MVD) mostly comprises two main functional abnormalities, which can occur in isolation or in combination:
In addition, other pathologies that affect the mitral valve include:
mitral valve prolapse
mitral annular calcification
Mitral valve prolapse (MVP) is often defined as systolic bowing of the mitral leaflet more than 2 mm beyond the annular plane into the atrium 1. It is a common cause of mitral regurgitation (considered most frequent cause of severe non-ischemic mitral regurgitation 2).
It may affe...
Mitral valve regurgitation, also known as mitral valve insufficiency or mitral valve incompetence, is a valvulopathy that describes leaking of the mitral valve during systole that causes blood to flow in the reverse direction from the left ventricle into the left atrium.
Mitral valve stenosis is a valvulopathy that describes narrowing of the opening of the mitral valve between the left ventricle and the left atrium.
Mitral stenosis is seen more commonly in women and in countries, generally developing nations, where rheumatic fever is common 1.
The moderator band, also called the septomarginal trabecula, is a consistent structure in the morphologic right ventricle and can be helpful as a landmark in situations where the ventricles may be ambiguous (i.e. in some forms of congenital heart disease).
The term "septomarginal" is descriptiv...
The 'moguls of the heart' refer to the bulges of the cardiomediastinal contour on frontal chest radiographs. The cardiomediastinal bulges are likened to skiing moguls (bumps of packed snow on a mountainside sculptured by turning skis). Awareness of their usual locations and etiologies is helpful...
The Mustard repair is a technique to correct transposition of the great arteries (TGA), and involves:
resection of atrial septum
creation of an atrial baffle with pericardium (or rarely synthetic material) 1
Transposition of the great arteries involves a discordance between the ven...
Myocardial bridging is a common congenital anomaly of the coronary arteries where a coronary artery courses through the myocardium.
It is found approximately in 20-30% of the adult population in autopsy studies. Incidence in coronary angiograms is between 2-15%.
Myocardial crypts (or myocardial clefts or fissures) refer to discrete clefts or fissures in otherwise compacted myocardium of the left ventricle. They are thought to represent a distinctive morphological expression of hypertrophic cardiomyopathy, occurring with different frequency in these pati...
Myocardial infarction (MI), an acute coronary syndrome, results from interruption of myocardial blood flow and resultant ischemia, and are a leading cause of death worldwide.
male > females
> 45 for males
> 55 for females
cardiovascular risk factors: smoking...
Myocardial perfusion and viability assessment is important for many reasons:
to diagnose, locate and grade the severity of coronary artery disease
to identify candidates who would benefit from re-vascularization
to evaluate response of re-vascularization
Myocarditis is a general term referring to inflammation of the myocardium.
Clinical presentation is variable in severity, ranging from asymptomatic to cardiogenic shock, but it typically is associated with other viral symptoms, including fever and malaise. It typically o...
The napkin-ring sign (heart) is a recently described sign encountered on CT coronary angiogram (coronary CTA) performed on modern MDCT. It has been shown to possess a high predictive value in predicting future cardiac events and is considered one of the imaging correlates of an unstable plaque. ...
Nonbacterial thrombotic endocarditis (NBTE), also referred as marantic endocarditis, refers to fibrin and platelets aggregations on previously undamaged heart valves, in patients without bacteraemia. The condition is seen in patients with advanced stage malignancies and is related to episodes of...
Non-compaction of the left ventricle, also known as spongiform cardiomyopathy, is an arrest of myocardial compaction during embryogenesis, leading to hypertrophic ventricular trabeculations and deep inter-ventricular recesses.
This abnormality has also been described in the right ventricular, b...
This article lists examples of normal imaging of the chest and surrounding structures, divided by modality.
PA adult male
example 2: with inverted windows
PA adult female
example 3: with labels
A detailed understanding of the structures that make up the normal contours of the heart and mediastinum (cardiomediastinal contour) on chest radiography is essential if abnormalities are to be detected.
Frontal view (PA/AP)
Right cardiomediastinal contour
From superior to inferior:
The Norwood procedure is a palliative surgical procedure performed in cases of hypoplastic left heart syndrome.
The procedure consists of constructing a neo-aorta by side-to-side anastomosis of the main pulmonary artery and ascending aorta. A modified Blalock-Taussig shunt is placed to provide ...
The oblique pericardial sinus is a blind-ending pericardial cul-de-sac behind the heart which opens into the pericardial space proper inferiorly.
It's boundaries are:
right (in ascending order): inferior vena cava, right inferior pulmonary vein and right superior pulmonary vein
The obtuse marginal (OM) arteries sometimes referred to as lateral branches are branch coronary arteries that come off the circumflex artery. There can be one or more obtuse marginal arteries. It typically traverses along the left margin of heart towards the apex. The first obtuse marginal arter...
Ortner syndrome, also known as cardiovocal syndrome, is characterised by hoarse voice resulting from left recurrent laryngeal nerve palsy secondary to a cardiovascular disorder.
Left recurrent laryngeal nerve palsy in this condition is due to traction or compression of the nerve betw...
Overall visual assessment of coronary artery calcification is a simple scoring system for risk assessment of coronary heart disease mortality by an overall "gestalt" of none, mild, moderate or heavy coronary artery calcification. It is comparable to the Agatston score but has the advantage of be...
A number of pediatric cardiovascular procedures are encountered when reporting pediatric imaging. They include:
Blalock-Taussig (BT) shunt
classic: end to side subclavian to ipsilateral pulmonary arterial anastomosis
modified: graft anastomosis
Sano shunt: right ventricle to...
Page kidney, or Page phenomenon, refers to systemic hypertension secondary to extrinsic compression of the kidney by a subcapsular collection, e.g. hematoma, seroma, or urinoma.
Patients present with hypertension, which may be recognized acutely after an inciting event or...
Panzerherz (or armoured heart) is a term used to describe the appearance of the heart in calcified constrictive pericarditis.
The pericardium becomes circumferentially thickened with calcification, limiting the ability of the heart to contract. The rim of dense calcification describes how the h...
Papillary fibroelastomas are rare benign primary cardiac tumours. However, of the primary cardiac tumours, they are one of the commonest to occur in relation to the cardiac valves (may account for 75% of valvular tumours 10).
Its estimated prevalence ranges between <0.01 to 0.33%...
The papillary muscles are thick bands and ridges of endocardial-lined myocardium that project into the lumen of the cardiac ventricles. They essentially represent dominant ventricular trabeculae which attach to the cusps of the atrioventricular valves via the chordae tendineae. During systole, t...
A parachute device or ventricular partitioning device is a percutaneously inserted cardiac device aimed at improving cardiac output and reducing cardiac remodelling in patients following myocardial infarction.
The device consists of an umbrella shaped frame with a overlying membrane,...
A parachute mitral valve is a valvular congenital abnormality usually identified in infants or young children though is can present later in adulthood.
Parachute mitral valves occur when all the chordae tendineae are attached to a single papillary muscle origin. Unlike the normal sit...
Partial anomalous pulmonary venous return (PAPVR), also known as partial anomalous pulmonary venous connection (PAPVC), is a rare congenital cardiovascular condition in which some of the pulmonary veins, but not all, drain into the systemic circulation rather than in the left atrium.
Passive hepatic congestion, also known as congested liver in cardiac disease, describes the stasis of blood in the hepatic parenchyma, due to impaired hepatic venous drainage, which leads to dilation of central hepatic veins and hepatomegaly.
Passive hepatic congestion is a well-studied result...
Patent ductus arteriosus or arteriosum (PDA) is a congenital cardiac anomaly where there is persistent patency of the ductus arteriosus, a normal connection of the fetal circulation between the aorta and the pulmonary arterial system that develops from the 6th aortic arch.
A patent foramen ovale (PFO) is a type of atrial septal defect in which there is channel-like communication between the atria through an unfused fossa ovale.
The foramen ovale in the interatrial septum normally develops into the fossa ovalis when the flaps of the atrial septa pri...
The pectinate muscles are "teeth of a comb" shaped parallel muscular columns that are present on the inner wall of the right and left atria.
The right atrium has thick and coarse pectinate muscles while these are few smooth and thinner in the left atrium.
History and etymology
The term is der...
The pentalogy of Fallot is a variant of the more common tetralogy of Fallot, comprising the classic four features with the addition of an atrial septal defect or patent ductus arteriosus:
ventricular septal defect (VSD)
right ventricular outlfow tract narrowing or complete obstruction
Pericardial agenesis is a rare condition where there is the absence of the pericardium to varying degrees. If it is only a small portion of the pericardium that is absent it is known as a pericardial defect.
According to a surgical and pathological series, the prevalence (inclusiv...
Pericardial cysts are uncommon benign congenital anomalies of the anterior and middle mediastinum.
Usually asymptomatic and discovered incidentally although occasionally may present with chest pain and dyspnoea.
They are thought to often result from aberration...
Pericardial diverticula are focal out-pouchings arising from the pericardium. They are differentiated from congenital pericardial cysts by the presence of direct communication with the pericardial cavity. They can be radiologically-identical to cysts and can be hard to distinguish from pericardi...
Pericardial effusions occur when excess fluid collects in the pericardial space (a normal pericardial sac contains approximately 30-50 mL of fluid).
There is no single demographic affected, as there are many underlying causes of a pericardial effusion.
Pericardial hemangioma is a location specific rare subtype of cardiac hemangioma which arises from either the parietal or visceral (commoner 3) pericardial layers.
Treatment and prognosis
It is a benign tumor. Treatment option vary from monitoring to resection.
The pericardial ligaments is a name given to a group of variable fibrous ligaments or adhesions that connect the pericardium to adjacent structures. These ‘ligaments’ tether the fibrous pericardium to it's surrounds, hence movements of the chest wall and diaphragm influence the position of the ...
Pericardial lipoblastomas are rare benign tumours that usually occur in children less than 3 years of age. They originate from embryonic fat cells and are divided into two forms, based on location 1:
superficial form: well-circumscribed and well-encapsulated
deep form: not well-circumscribed a...
Pericardial lipomas are slowly growing benign tumours of the pericardium that are asymptomatic unless large in size, where they can cause pressure symptoms.
Tends to be echogenic structure adjacent or inside the pericardium.
Seen as a fatty attenuat...
Pericardial mesothelioma refers to a mesothelioma arising primarily from the pericardium.
They are rare and are only thought to account for ~0.7% of all malignant mesotheliomas. There is male to female predominance of approximately 3:1.
The presentation of...
The pericardial recesses are small spaces in the pericardial cavity arising from the transverse pericardial sinus that are formed by the reflections of the pericardium. Pericardial fluid can pool in these recesses, mimicking mediastinal lymph nodes or pathology. There are several pericardial re...
The pericardial space or cavity is the fluid-filled space in between the parietal and visceral layers of the serous pericardium. In normal conditions it contains only a small amount of serous pericardial fluid, usually 15-20 mL.
A pericardial effusion is the pathological accu...
Pericardial teratomas are type of primary pericardial tumor. They are usually diagnosed in infants and neonates. As with all teratomas, they are comprised of contain endodermal, mesodermal and neuroectodermal germinal layers. While they are usually benign tumours, they may be life-threatening d...
There are a number of tumours that can involve the pericardium. They include
primary pericardial tumours
primary pericardial mesothelioma
primary pericardial lymphoma
Pericardial window is a procedure performed to create a fistula or "window" from the pericardial space to the pleural space. It is done to allow a pericardial effusion to drain the chest cavity in order to relieve situations with increased pressures such as with cardiac tamponade.
Pericarditis is defined as inflammation of the pericardium. It is normally found in association with cardiac, thoracic or wider systemic pathology and it is unusual to manifest on its own.
In general, infection is the most common cause of pericarditis. Infection accounts for two-thir...
The pericardium is a conical, flask-like, fibroserous sac which contains the heart and the roots of the great vessels and defines the middle mediastinum.
The pericardium is made of two sacs in one. The outer sac is the fibrous pericardium and the inner sac is the double-layered ...
Peri-partum/post-partum cardiomyopathy is a dilated cardiomyopathy that may occur in the last trimester of pregnancy through the first several months post-partum.
The pathogenesis of post-partum cardiomyopathy is uncertain, with genetic factors, sympathetic tone, hormones, and malnut...
PET-CT is a combination of cross-sectional anatomic information provided by CT and the metabolic information provided by positron emission tomography (PET).
PET is most commonly performed with 2-[F-18]fluoro-2-deoxy-D-glucose (FDG). Fluorine-18 (F-18) is an unstable radioisotope and has a half-...
Sir Peter “PK” Kerley (1900-1979) was a globally-renowned cardiothoracic radiologist who is primarily remembered now for his Kerley lines but in his lifetime was famed for his uncanny imaging diagnostic abilities, co-editing the famous 'Textbook of X-ray Diagnosis', and co-founding the Faculty o...
PHACE syndrome, also known as cutaneous hemangioma–vascular complex syndrome or Pascual-Castroviejo type II syndrome, is a phakomatosis that comprises of:
P: posterior fossa malformations (e.g. Dandy-Walker malformation)
A: arterial anomalies
C: coarctation of the aorta and ca...
Pigs-in-a-blanket sign refers to the CT appearance of coronary pseudotumors, which are observed in IgG4-related coronary periarteritis. This appears as a soft tissue mass surrounding the involved segment of the coronary artery.
Pink tetralogy of Fallot refers to a tetralogy of Fallot in which the degree of right ventricular outflow obstruction is minimal, resulting no significant right to left shunt, and therefore no cyanosis. Symptoms are mild and presentation may be delayed, even into adulthood.
Pneumopericardium represents gas (usually air) within the pericardium, thus surrounding the heart.
Underlying causes include:
positive pressure ventilation
thoracic surgery/pericardial fluid drainage
blunt trauma (rare)
infectious pericarditis with ...
The point-of-care ultrasound (PoCUS) curriculum is one of our curriculum articles and aims to be a collection of articles that represent the core applications of ultrasonography in a point-of-care setting.
Point-of-care ultrasound refers to ultrasonography which may be simultaneously performed,...
Polyarteritis nodosa (PAN) is a systemic inflammatory necrotising vasculitis that involves small to medium-sized arteries (larger than arterioles).
PAN is more common in males and typically presents around the 5th to 7th decades. 20-30% of patients are hepatitis B antigen positiv...
Porcelain left atrium, also known as coconut left atrium, is a term used when a large part of or the entire left atrial wall becomes calcified. It can occur as a rare consequence of endocarditis (with underlying rheumatic heart disease). It has also been described in the setting of end-stage ren...
The postcaval recess is one of the pericardial recesses forming a small space within the pericardium, which arises from the transverse pericardial sinus. It is located posterior to the superior vena cava and superior to the right superior pulmonary vein.
It may mimic mediastinal lymphadenopathy...
The posterior left ventricular (PLV) artery, also known as the posterolateral artery (PLA), is a terminal branch of the coronary arterial system supplying the inferior portion of the heart. It usually arises from the right coronary artery (in a right dominant circulation) but can less commonly a...
The posterior vein of the left ventricle is a vein of the heart which courses over the inferior wall of the left ventricle and drains into the coronary sinus to the left of where the middle cardiac vein drains into the sinus. It drains, not unsurprisingly, the inferior wall of the left ventricle.
Cardiovascular postmortem changes refer to the normal appearances of the cardiovascular system on postmortem imaging.
hyperdensity of the aortic wall 1,2
hypostasis of blood intravascularly 3
dilatation of the right atrium of the heart 1
dilatation of the superior...
Post-sternotomy complications comprise of a varied range problem that can occur at varying durations after a median sternotomy. Imaging playing in detection and aiding management.
Complication rates for median sternotomy have been reported to range from 0.5-5%, with mortality rate...
A Pott shunt is a form of palliative surgery performed in patients with tetralogy of Fallot prior to the ability to repair the defect. It consists of a shunt formed between the descending thoracic aorta and the left pulmonary artery.
This does not relieve the right ventricular outflow obstructi...
Primary benign cardiac tumours are much less common than secondary metastatic deposits. However they are more likely when a cardiac mass is seen outside of the setting of terminal metastatic disease. Tumours include 1-2:
most common in adults
accounts for ~50% of all primary be...
Primary cardiac tumours are uncommon, and comprise only a small minority of all tumor that involve the heart: most are mediastinal or lung tumours which extend through the pericardium and into the heart, or metastases 1.
Primary cardiac tumours have an estimated autopsy prevalence...
Primary malignant cardiac tumours are rare, and account for only ~25% of primary cardiac tumours, and only a small proportion of all malignant tumours which involve the heart: direct extension of adjacent tumours or metastatic deposits are far more common. Histologcal types include 1:
Prosthetic cardiac valves are a routine finding on chest X-ray. The frequency and degree of exposure is greatest in larger hospitals with cardiothoracic centres, however, prosthetic valves are commonplace universally.
Recognition of which valve has been replaced, any other related cardiothoraci...
Prosthetic heart valves are common. The four valves of the heart may all be surgically replaced. However, aortic and mitral valves are the most commonly replaced.
Replacements may be tissue or metallic valves, only the latter being visualized on imaging investigations. Sometimes the annulus alo...
Pseudocoarctation of the aorta is a very rare anomaly characterised by kinking or buckling of the descending aorta at the level of the ligamentum arteriosum without a pressure gradient across the lesion.
It is thought to be of congenital origin, and characterised by elongation and ki...
Pulmonary artery atresia (or sometimes known as pulmonary atresia) is a congenital cardiovascular anomaly in which there is complete disruption between the right ventricular outflow tract (RVOT) and the pulmonary trunk.
The estimated incidence is 1 in 10,000 births.
Pulmonary artery banding is a palliative surgical procedure used to decrease excessive pulmonary blood flow. It is usually used for neonates and infants with left-to-right shunts unable to withstand complete surgical correction.
Some indications include:
Pulmonary atresia with intact interventricular septum (PA-IVS) is a subtype of pulmonary atresia that presents as cyanotic congenital heart disease.
PA-IVS is the combination of obstruction of the pulmonary outflow tract from pulmonary valve atresia without a ventricular septal defe...
There are numerous causes of pulmonary hypertension, and thus not surprisingly there have been many classification systems.
In 2003, the 3rd World Symposium on PAH met in Venice and produced an updated classification system (this has been further revised in the Dana Point classification of pulm...
The classification system for pulmonary hypertension was revised at the 4th World Symposium on Pulmonary Hypertension held in Dana Point, California, in 2008 1.
This system is as follows:
group 1: pulmonary arterial hypertension
1.1: idiopathic pulmonary arterial hypertension
1.2: heritable ...
In 2013, the 5th World Symposium on pulmonary hypertension took place in Nice, France and modified the classification system for pulmonary hypertension.
The modified system divides pulmonary hypertension into five groups:
group 1: pulmonary arterial hypertension (disorders of the pulmonary ar...
Pulmonary hypertension has many causes, and these can be divided in many ways. A simple and systematic approach is to proceed along the cardiopulmonary pulmonary circulation, as causes are found at each site (for a more official classification system see 2003 third world symposium on pulmonary a...
The pulmonary valve is one of the four cardiac valves. It is the semilunar valve that allows blood to exit the right ventricle. It opens during systole and closes during diastole. The valve has anterior, left and right cusps, the bases of which attach around the valve orifice to a fibrous ring o...
Pulmonary valve regurgitation, also known as pulmonary valve insufficiency or pulmonary valve incompetence, is a valvulopathy that describes leaking of the pulmonary valve diastole that causes blood to flow in the reverse direction from the pulmonary trunk and into the right ventricle.
Pulmonary valve stenosis, or pulmonic valve stenosis, is a valvulopathy that describes narrowing of the opening of the pulmonary valve between the pulmonary trunk and the right ventricle.
Pulmonary stenosis is nearly always (95%) congenital, and therefore primarily affects the ped...
Pulmonary vein stenosis refers to a spectrum of conditions characterised by narrowing of the pulmonary veins. It can be congenital or acquired.
primary pulmonary vein stenosis - occurs in children
secondary pulmonary vein stenosis - occurs in adults and usually associated with some identifiabl...
Quadricuspid aortic valve (QAV) is a rare cardiac valvular anomaly where the aortic valve has four cusps, instead of the usual three.
The estimated incidence on necropsy at ~1 in 8,000. While the incidence of QAV on 2D echocardiography has been reported to range between 0.01-0.04%...
Radiation-induced heart disease, also known as radiation cardiotoxicity, describes an uncommon constellation of potential cardiac complications of mediastinal radiotherapy.
The demographics of patients affected by radiation-induced heart disease are those of the underlying conditi...
Raghib syndrome is a rare developmental complex. It consists of:
persistence of the left superior vena cava
coronary sinus ostial atresia
atrial septal defect
It has also been associated with other congenital malformations including ventricular septal defects, enlargement of the tricuspid an...
The rapid ultrasound in shock (RUSH) protocol is a structured point-of-care ultrasound (POCUS) examination performed at the time of presentation of a shocked patient. It is a more detailed and longer exam than the FAST scan, with the aim to differentiate between hypovolemic, cardiogenic, obstruc...
RASopathies are a class of developmental disorders caused by germline mutations in genes that encode for components or regulators of the Ras/mitogen-activated protein kinase (MAPK) pathway.
As a group, RASopathies represent one of the most common malformation syndromes, with an in...
The Rastelli procedure is a surgical procedure to correct certain combinations of cardiovascular defects in patients with cyanotic congenital heart disease.
The operation is based on a redirection of ventricular outflows using an intracardiac baffle that tunnels the left ventricle to...
Restrictive cardiomyopathy is the least common subtype of cardiomyopathy and is characterised by a marked decrease in ventricular compliance.
Patients can present with symptoms and signs of left ventricular failure and/or right ventricular failure 9.
It is p...
Cardiac rhabdomyosarcoma is a muscular tumor that arises in the heart.
They account for only 4-7% of cardiac sarcomas overall but are the most common cardiac malignancy in infants and children. There is a slight male predilection.
Cardiac rhabdomyosarcoma hav...