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E1397. Subtle Cardiovascular Findings on CT: Using Contextual Clues for Precise Diagnosis
Authors
  1. Lawrence McDermott; Rutgers New Jersey Medical School
  2. Pierre Maldjian; Rutgers New Jersey Medical School
Background
In certain unusual cases, there can be an obvious finding on CT, while an additional key finding may remain elusive. The challenge for the radiologist is to seek out all related findings and to correctly integrate them to arrive at the correct diagnosis. This requires knowledge of and an index of suspicion for these uncommon disorders. In the context of particular obvious abnormalities, the mind can direct the eye towards the more subtle clues for precise diagnosis. This presentation is a case-based illustration of various subtle cardiovascular findings, which can easily be overlooked by the unsuspecting radiologist when associated with more obvious abnormalities.

Educational Goals / Teaching Points
The goals of this presentation are: to illustrate and discuss subtle key cardiovascular findings on CT, which are usually associated with other more obvious abnormalities; to review the clinical implications for these disease processes; and to familiarize radiologists with these entities in order to develop an index of suspicion for these unusual disorders or radiological presentations.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
This presentation is organized in cases. First, we cover cases illustrating abnormalities associated with pulmonary embolism (PE), including PE on noncontrast CT, clots in transit, paradoxical embolism, the “reverse halo sign” in cases of inconspicuous PE, and subtle findings of chronic PE. Next, subtle intracardiac filling defects and clues to look for them, such as thrombus, neoplasm, and endocarditis, are discussed. Finally, we present cases illustrating common cardiovascular congenital anomalies in adults and their signposts, including atrial septal defects, partial anomalous pulmonary venous return, patent ductus arteriosus and aortic coarctation. For each case, we provide a teaching point to summarize the critical issues.

Conclusion
Discerning subtle cardiovascular findings on CT and properly incorporating them into the overall picture is challenging for the radiologist. Familiarity with particular disease processes and their associated manifestations on CT is crucial to facilitate prompt and accurate diagnosis.