4a. Thorax Radiology - Congenital Pathologies

Question 1

what is the normal path of blood through the heart and what are the relative pressures in the left and right halves of the heart

Answer 1

IVC and SVC drain into right atrium and through tricuspid valves

right atrium to ventricle and pulmonary valve into pulmonary artery into lungs

lungs to pulmonary arteries through mitral valve and to left atrium

pressure in left heart is higher than right heart

Question 2

what is atrial septal defect/patent foramen ovale in terms of anatomy

Answer 2

communication/hole between right atrium and left atrium

Question 3

what happens in atrial septal defect/patent foramen ovale

in terms of abnormal blood flow in heart

Answer 3

pressure in left is higher than right side so blood goes from left atrium into right atrium - path of least resistance - into right ventricle and into lungs back into right atrium and some goes back to right ventricle of heart

blood flow to lungs higher than blood flow to body and body is starved of blood and lungs get too much plod volume per beat

Question 4

what does atrial septal defect case

x 3 things

Answer 4

right side heart failure
pulmonary hypertension
risk of stroke

Question 5

why does atrial septal defect cause right sided heart failure

Answer 5

high volume of blood going into right side

Question 6

why does atrial septal defect cause pulmonary hypertension

Answer 6

lungs arent meant to have lots of blood through them so they increase resistance to try stop as much blood entering them (path of least resistance principle)

Question 7

why does atrial septal defect increase risk of stroke

Answer 7

communication between right and left heart so thrombosis could go into systemic circulation or lung causing stroke

Question 8

what is ventricular septal defect in terms of anatomy

Answer 8

hole in septum between right and left ventricle

Question 9

what is ventricular septal defect in terms of physiology

Answer 9

high pressure in left ventricle and less resistance going into right side than into aorta so blood goes into right heart rather than aorta from left ventricle

Question 10

what does ventricular septal defect cause x 4 things

Answer 10

heart failure
pulmonary hypertension
valve disease
rhythm disorders

Question 11

why does ventricular septal defect cause valve disease

Answer 11

associated with mitral and tricuspid valve

Question 12

what is coarctation of aorta

in terms of anatomy and physiology

Answer 12

ascending aorta goes up and beyond that where branches are there is a tight stenosis so blood on ascending side have higher pressure than descending side

Question 13

what does coarctation do to the pressure in body upper and lower

Answer 13

increases pressure to brain and arms

lower pressure going into legs

Question 14

what does coarctation of the aorta cause x 4 things

Answer 14

hypertension
aneurism
risk of stroke
heart failure

Question 15

why does coarctation of aorta cause hypertension

Answer 15

blood going to kidney - kidney regulates pressure - is low pressure so kidney sends signal to increase pressure

Question 16

why does coarctation of aorta cause heart failure

Answer 16

heart does more work to get blood into descending aorta

Question 17

how do you fix coarctation of the aorta

Answer 17

catheter into aorta and pass it up

wire across narrowing and blow up balloon in the narrowing and put stent over balloon

Question 18

what is the ductus arteriosus and what does it do

Answer 18

its the communication between the pulmonary artery and aorta as there is no point in blood going to lungs as they are not oxygenated so mostly blood bypasses lungs and go straight into aorta

this is because resistance in lungs is very high so blood goes where resistance is lowest which is where aorta is

Question 19

what happens to the ductus arteriosus after youre born

Answer 19

it closes down and normal adult configuration from right ventricle to pulmonary artery and doesnt go into aorta

Question 20

what happens if the ductus arteriosus is left open after birth

Answer 20

blood from aorta can go back into pulmonary artery as pressure is pulmonary is lower than pressure in aorta and gets increased blood flow through lungs

Question 21

what are the 3 things that patent ductus arteriosus cause

Answer 21

pulmonary hypertension
endocarditis
heart failure

Question 22

what is bicuspid aortic valve

Answer 22

instead of 3 valve leaflets for the bicuspid valve there are 2 leaflets

Question 23

what is cystic fibrosis

Answer 23

autosomal recessive disease where mucus in lungs is sticky and cant be coughed up so stays in lungs and cant clear bacteria and dust from lungs

bacteria stay in lungs and fester destroying lungs and there is pus in lungs

Question 24

how do you treat cystic fibrosis

Answer 24

gene therapy, antibiotics, lung transplant

Question 25

what is seen in CT for cystic fibrosis

Answer 25

fluid in CT lungs as stagnant pus that patient cant cough up

Question 26

what is alpha antitrypsin deficiency

Answer 26

alpha antitrypsin in lungs stops lungs from autoingesting itself so deficiency means you destroy your own lungs

Question 27

what does alpha antitrypsin deficiency look like on images

Answer 27

not very many lung markings on dead lung

Question 28

what do you do with alpha antitrypsin deficiency

Answer 28

remove dead lung so rest of lungs can work better and can plan surgery with CT images

Question 29

what is oesophageal atresia

Answer 29

can be partial, complete or blocked sometimes communicates with bronchus blocked oesophagus

Question 30

what does oesophageal atresia look like in a in utero US image

Answer 30

sagittal view of baby shows no bright amniotic fluid in babys gut as it cant swallow fluid

Question 31

what is achalasia of the oesophagus

Answer 31

blockage of oesophagus distal end of oesophagus there is spasms prevents content of oesophagus from going into stomach

Question 32

what does achalasia of the oesophagus look like on CT images

Answer 32

dilated sac of oesophagus is full of old food unable to pass gastro-oesophageal junction

Question 33

why is achalasia of the oesophagus associated with pneumonia

Answer 33

when patient goes to sleep the content of oesophagus gets aspirated into lungs while asleep

Question 34

what is a broncho-pleural fistula

Answer 34

communication between pleural space and bronchi/lungs - usually pneumothorax

Question 35

what will you see on a CT image for a broncho-pleural fistula

Answer 35

pneumothorax

Question 36

what is a tracheo-esophageal fistula

Answer 36

communication between airways and oesophagus

Question 37

what is tracheo-esophageal fistula often caused by

Answer 37

bronchial carcinoma or cancer

Question 38

what is diaphragmatic hernia

Answer 38

heart pushed into right side of chest and chest has loops of bowels dur to hole in diaphragm

Question 39

what is hiatus hernia

Answer 39

abnormality of oesophagus where fundus of stomach slides through oesophageal hiatus into chest stomach pulled through chest

Question 40

what does hiatus hernia look like on xray and CT

Answer 40

fluid levels behind heart on erect xray film fiscus too wide to be oesophagus and fluid levels

Question 41

is artial septal defect/patent foramen ovale a congenital disease in infants or adults

Answer 41

infancy

Question 42

is ventricular septal defect/patent foramen ovale a congenital disease in infants or adults

Answer 42

infancy

Question 43

is coarctation a congenital disease in infants or adults

Answer 43

infancy

Question 44

is patent ductus arteriosus a congenital disease in infants or adults

Answer 44

infancy

Question 45

is bicuspid valves a congenital disease in infants or adults

Answer 45

adults

Question 46

is cystic fibrosis a congenital disease in infants or adults

Answer 46

infancy

Question 47

is alpha 1 antitrypsin deficiency a congenital disease in infants or adults

Answer 47

adults

Question 48

is atresia/hypoplasia a congenital disease in infants or adults

Answer 48

infancy

Question 49

is achalasia a congenital disease in infants or adults

Answer 49

adults

Question 50

is fistulas (broncho-pleura) a congenital disease in infants or adults

Answer 50

adults

Question 51

is fistulas (tracheo-oesophageal) a congenital disease in infants or adults

Answer 51

adults

Question 52

are hernias (diaphragmatic) a congenital disease in infants or adults

Answer 52

adults

Question 53

are hernias (hiatus hernia) a congenital disease in infants or adults

Answer 53

adults