Intramyocardial lipomas are rare benign cardiac tumors that often present a diagnostic dilemma due to their nonspecific clinical and imaging features on initial evaluation. We report the case of a 40-year-old asymptomatic male who presented with a large intramyocardial lipoma arising from the basal inferior wall of the left ventricle. Initial transthoracic echocardiography revealed an echogenic mass in the region of the left ventricle basal septum but was insufficient for definite characterization. Cross-sectional imaging, including computed tomography (CT) and cardiac magnetic resonance imaging (MRI), demonstrated a homogeneous fat-density mass consistent with lipoma. This case highlights the pivotal role of multimodality imaging in accurately characterizing a rare primary cardiac tumor.

BACKGROUND Bicuspid aortic valve (BAV) affects 0.5%-2% of the population and is associated with progressive aortopathy leading to life-threatening complications. Aortic size index (ASI) adjusts aortic dimensions for body surface area (BSA), potentially improving risk stratification. AIM To characterise BAV-associated aortopathic changes using third-generation dual-source computed tomography (CT) and to derive a cohort-specific ASI threshold associated with CT-defined ascending aortic dilatation in an Indian population. METHODS This prospective cross-sectional study enrolled 100 BAV patients (age > 18 years) from July 2022 to November 2023. All patients underwent CT aortography using 192-slice third-generation dual-source CT scanner (Somatom Force, Siemens). Aortic measurements were obtained at multiple levels including annulus, sinus of Valsalva, ascending aorta, arch, and descending thoracic aorta. ASI was calculated as maximum ascending aortic diameter divided by BSA. Statistical analysis included receiver operating characteristic curve analysis and correlation coefficients. RESULTS Mean age was 48.95 ± 13.78 years, with 64% males. Ascending aortic dilatation was present in 87% of patients, with a mean diameter of 42.79 ± 8.69 mm. Mean ASI was 25.13 ± 5.71 mm/m2 with 42% having ASI > 25 mm/m2 (high-risk category). ASI strongly correlated with ascending aortic diameter (rho = 0.87, P < 0.001). At ASI cutoff ≥ 23.8 mm/m2 sensitivity was 84% and specificity 90% for predicting aortic dilatation > 40 mm. The mean measurement difference between CT and echocardiography was 11.72 ± 8.27 mm. CONCLUSION In this single-centre cohort of Indian patients with BAVs, an ASI threshold of 23.8 mm/m2 was associated with CT-defined ascending aortic dilatation and may serve as a cohort-specific reference for risk stratification. Because ASI is mathematically derived from ascending aortic diameter, this finding should be interpreted as a cohort-specific threshold rather than independent validation of ASI as a predictor. Third-generation dual-source CT yielded larger absolute aortic measurements than transthoracic echocardiography; this difference is likely partly methodological, reflecting non-equivalent measurement sites, measurement conventions, and inherent limitations of 2D echocardiography in BAV.

Congenital aorta-right atrial tunnel (ARAT) is a rare cardiovascular lesion and has a varied clinical presentation. Angiographically, these must be differentiated from relatively common entities such as ruptured sinus of Valsalva aneurysms and coronary-cameral fistulas. Management protocols vary depending on anatomical course/caliber of the tunnel and the status of the coronary ostia. We describe a case of a 36-year-old male patient who was diagnosed with this entity on computed tomography angiography and underwent successful surgical repair.

We present the case of a 9-year-old girl who underwent cardiac computed tomography angiography to evaluate ventricular septal defect (VSD) with pulmonary atresia. Imaging revealed a rare anomalous drainage of the left superior pulmonary vein into a retroaortic left brachiocephalic vein (LBCV). This vein coursed posterior to the ascending aorta before joining the right brachiocephalic vein (RBCV) to form the superior vena cava (SVC). Recognition of this uncommon combined anomaly is essential to prevent misinterpretation on imaging and to ensure appropriate surgical planning when intervention is necessary.

This case describes a 55-year-old man who presented with complaints of claudication in his left upper limb. Computed tomography angiography revealed a rare anatomical variant in which the left vertebral artery originated from the left thyrocervical trunk.

Cardiomyopathy (CMP) related heart failure (HF) is a leading cause of disability and death. Using novel cardiac magnetic resonance imaging (CMRI), late gadolinium enhancement (LGE) is detected as an imaging marker of myocardial fibrosis. Over the last few years there is increased percentage of ischemia related heart failure, subjecting patients to invasive catheter angiography for detection of coronary artery disease (CAD). This study evaluates the role of Dual energy cardiac computed tomography (DECT) as a one-step modality to diagnose coronary artery disease and myocardial fibrosis in a single step investigation. The aim of the study is to assess the diagnostic performance of DECT in the evaluation of myocardial delayed enhancement (MDE) with LGE MRI as the standard of reference. Thirty patients of heart failure with reduced ejection fraction (<40%) who were diagnosed with myocardial scar (LGE) on CMRI underwent DECT coronary angiography and delayed scan at 8 to 10 minutes for assessment of MDE, mainly assessing the coronary vascular status and the pattern of MDE detection. The MDE images (virtual monochromatic [VM] and iodine density maps) were compared with the LGE images, with LGE as the gold standard. The diagnostic accuracy of iodine density map and VM images as compared with LGE in CMRI is 76 and 66%, respectively (p < 0.001). The sensitivity and specificity of virtual monochromatic images as compared with iodine density maps is 86.96 and 100%, respectively, with a kappa value of 0.757 consistent with the statistically significant result. DECT angiography with MDE is a robust investigation to detect coronary artery disease and myocardial fibrosis in the same sitting with comparable performance when compared with CMRI-derived LGE imaging.

Interrupted aortic arch (IAA) is a congenital anomaly characterized by a discontinuity between the ascending and descending aorta. We present a 27-year-old male patient who had presented with Stanford Type A aortic dissection and was subsequently found to have IAA on computed tomography aortogram. The patient subsequently underwent emergency surgery for the repair of aortic dissection. Although few studies with IAA and coexistent Stanford type-B aortic dissection have been described, there is no reported case in literature on IAA with Stanford Type A aortic dissection.

Scientific papers are the driving force for research, information dissemination, and policymaking that directly impacts society. Thus, ethical practices are the elixir of publications. Adherence to ethical practices promotes integrity in research and publication. Transgression of ethics is thus considered a poison to science. Although there is no definition of ethics, it includes a systematic approach that not only recommends but also defends and protects concepts of the conduct of right and wrong. Therefore, ethical principles should be strictly adhered to and upheld at any cost for the progression of science. This article addresses various actions that are considered ethical misconduct and guidelines to fix them. Recommendations of various organizations related to the ethics in publications are also discussed.

HomeRadiology: Cardiothoracic ImagingVol. 6, No. 1 PreviousNext Images in Cardiothoracic ImagingCardiac ImagingUnilateral Anomalous Pulmonary Venous Return into Coronary SinusPavithra Subramanian, Sanjeev Hanumanthacharya Naganur, Arun Sharma , Manphool SinghalPavithra Subramanian, Sanjeev Hanumanthacharya Naganur, Arun Sharma , Manphool SinghalAuthor AffiliationsFrom the Departments of Radiodiagnosis and Imaging (P.S., A.S., M.S.) and Cardiology (S.H.N.), Postgraduate Institute of Medical Education and Research, Madhya Marg, Sector 12, Chandigarh 160012, India.Address correspondence to A.S. (email: [email protected]).Pavithra SubramanianSanjeev Hanumanthacharya NaganurArun Sharma Manphool SinghalPublished Online:Feb 8 2024https://doi.org/10.1148/ryct.230359MoreSectionsFull textPDF ToolsAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookXLinked In References1. Dillman JR, Yarram SG, Hernandez RJ. Imaging of pulmonary venous developmental anomalies. AJR Am J Roentgenol 2009;192(5):1272–1285. Crossref, Medline, Google Scholar2. ElBardissi AW, Dearani JA, Suri RM, Danielson GK. Left-sided partial anomalous pulmonary venous connections. Ann Thorac Surg 2008;85(3):1007–1014. Crossref, Medline, Google ScholarArticle HistoryReceived: Sept 23 2023Revision requested: Oct 6 2023Revision received: Jan 9 2024Accepted: Jan 11 2024Published online: Feb 08 2024 FiguresReferencesRelatedDetailsRecommended Articles Cardiac Type of Partial Anomalous Pulmonary Venous ConnectionRadiology: Cardiothoracic Imaging2020Volume: 2Issue: 1Comprehensive Cross-sectional Imaging of the Pulmonary VeinsRadioGraphics2017Volume: 37Issue: 7pp. 1928-1954A Rare Pulmonary-Systemic Connection: Levoatriocardinal VeinRadiology: Cardiothoracic Imaging2020Volume: 2Issue: 2Anomalous Single Pulmonary Venous TrunkRadiology: Cardiothoracic Imaging2024Volume: 6Issue: 1Left Atrial Fibrosis Assessed with Cardiac MRI in Patients with Paroxysmal and Those with Persistent Atrial FibrillationRadiology2019Volume: 292Issue: 3pp. 575-582See More RSNA Education Exhibits Venous Anatomic Variants In The ThoraxDigital Posters2022The Vessel Coming Out of Left Field: A Brief Review of the Persistent Left Superior Vena Cava Together With Its Differential DiagnosesDigital Posters2020Cased-based Imaging Review of Fetal Venous System AnomaliesDigital Posters2020 RSNA Case Collection Partial anomalous pulmonary venous returnRSNA Case Collection2021Infra-diaphragmatic Total Anomalous Pulmonary Venous ReturnRSNA Case Collection2021Right upper PAPVR and persistent left SVCRSNA Case Collection2020 Vol. 6, No. 1 Metrics Altmetric Score PDF download

Computed tomography coronary angiography (CTCA) is a technically demanding radiological investigation that requires adequate opacification of coronary arteries at peak aortic enhancement phase, with minimal or no contrast in the superior vena cava and right-sided cardiac chambers to avoid streak artifacts of dense contrast. Therefore, it is prudent to know about contrast media, contrast kinetics, and contrast injection protocols. This article attempts to describe the essentials of various aspects of contrast media that should be considered for CTCA along with an in-depth analysis of contrast kinetics that every radiologist should know for obtaining adequate opacification of coronary arteries.

Aorto-cardiac tunnels represent uncommon cardiovascular anomalies connecting the ascending aorta to cardiac chambers and are typically characterized by extra-cardiac tubular channels. Among these, the involvement of the left atrium is exceptionally rare, with only a few cases reported in literature. Here, we describe a case of an aorto-left atrial tunnel in a 6-year-old boy with an associated bicuspid aortic valve, a large patent ductus arteriosus, and atrial septal defects. This case highlights the significance of multimodal imaging in the accurate identification and characterization of rare cardiovascular anomalies.

Congenital anomalies of inferior vena cava are increasingly being recognized with the technical advancements and increased utilization of cross-sectional imaging techniques. Duplication of inferior vena cava classically involves duplication of the infrarenal segment, where both inferior vena cava ascend on either side of the abdominal aorta until they form a confluence at the level of the renal veins. It has been extensively described in literature with few reports of more complex variation in the form of duplicated infrarenal inferior vena cava with azygos or hemiazygos continuation. This article describes extremely rare complete duplication of inferior vena cava involving both suprarenal and infrarenal segments. Moreover, the complete duplication of inferior vena cava is seen in association with concomitant double superior vena cava, in a patient with visceroatrial situs solitus and associated congenital heart disease, which to the best of our knowledge, has not been reported so far in literature. This study also highlights the utility of multidetector computed tomography in accurate identification of such anomalies.

Partial anomalous pulmonary venous drainage is a congenital cardiac disorder characterized by abnormal drainage of one or more pulmonary veins into the systemic circulation. It can be isolated or associated with other congenital cardiac anomalies, most commonly atrial septal defect and patent ductus arteriosus. The clinical presentation is variable and depends on the degree of shunting and associated cardiac anomalies. Many patients usually remain asymptomatic until late in life. In this article, we presented a complex case of obstructive partial anomalous pulmonary venous drainage with dual drainage of bilateral accessory pulmonary veins with intact interatrial septum in conjunction with a patent ductus arteriosus and a ventricular septal defect. This pattern is incredibly rare and to the best of our knowledge has not been previously reported. Computed tomography played a pivotal role in precisely elucidating the intricate anatomy in this case with a complex pattern of anomalous pulmonary venous drainage.