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CTPA breakdown looking for other causes of breathlessness
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Video Source: www.youtube.com/watch?v=VNdgE4U2yKg
A male in his 60s presents with breathlessness and has a CTPA. What does it show? • • • ———————— • DILATED CARDIOMYOPATHY AND PULMONARY OEDEMA • 👨🏽💻The initial CTPA shows no PE however look at the left ventricle - it is dilated measuring more than 7 cm in diameter • 👨🏽💻This suggests left ventricular dysfunction. Once you’ve seen this look for signs of pulmonary oedema to account for the breathlessness. It is subtle but there is smooth interlobar septal thickening, the most common cause of which is pulmonary oedema. There is also bilateral central groundglass opacity • 👨🏽💻Cardiac CT shows no obstructing coronary disease and cardiac MRI shows no subendocardial enhancement which would be expected if ischaemia was the primary cause • 👨🏽💻This case most likely represents an idiopathic dilated cardiomyopathy - linear mid wall enhancement on late gadolinium images can be seen in this but usually affects the septal wall • 👨🏽💻The key here is to be wary of smooth interlobular septal thickening on CT - if you see it at least think about pulmonary oedema. Also review the left ventricle as dilated LV on CT can be easy to miss if not looked for • FIND THIS USEFUL? FOLLOW FOR THE WHOLE SERIES OF CASE EXPLANATIONS • You can also find them all easily on my YouTube channel • 🔻@theradiologistpage • ———- • ✅Patient consent obtained • #theradiologist #radiology #radiologist #physician #physicianassistant #medicine #medstudent #medicalstudent #medschool #medicalschool #radtech #xray #medical #chestxray #doctor #medicalstudents #frcr
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