Cardiovascular Imaging
Core concepts
Understand the imaging of coronary artery disease: calcium scoring, CT coronary angiography, and the role of functional testing. Know the appearance of aortic dissection (intimal flap, true vs false lumen), aneurysm (diameter thresholds for intervention), and intramural hematoma. Recognize pulmonary embolism on CT pulmonary angiography (filling defect, right heart strain). Master cardiac chamber anatomy and the signs of heart failure (cardiomegaly, pulmonary edema, pleural effusions). Understand the imaging of pericardial disease (effusion, calcification in constrictive pericarditis) and valvular disease. Know the basics of vascular imaging: stenosis grading, plaque characterization, and the role of MRA versus CTA.
Traps
Do not mistake an intimal flap for artifact; confirm on multiple planes. A normal calcium score does not exclude noncalcified plaque. Beware attributing cardiomegaly to heart failure without other signs. Distinguish true from false lumen in dissection by size, contrast, and the beak sign.
Rule of thumb
In aortic dissection, the false lumen is usually larger, less enhanced, and may show a cobweb sign or beak sign.
Worked example
A patient with tearing chest pain: CTA shows an intimal flap in the ascending aorta, classifying a Stanford type A dissection, which requires emergent surgery.