Cardiovascular Radiology
Cardiovascular Radiology
This domain covers cardiac and great-vessel imaging: acute aortic syndrome, pulmonary embolism, coronary CTA, pericardial disease, and congenital heart disease. The exam emphasizes protocol choice and urgent findings.
Core rules
- Acute aortic syndrome includes dissection (intimal flap, true and false lumens), intramural hematoma (crescentic high attenuation without flow), and penetrating atherosclerotic ulcer. Ascending aortic involvement is Stanford type A and surgical.
- CTA pulmonary embolism: a filling defect in a contrast-opacified artery. Right ventricular enlargement with RV/LV ratio >1 suggests strain; it modifies risk but not the diagnosis.
- Coronary CTA uses CAD-RADS: 0 none, 1–2 mild, 3 moderate, 4 severe/obstructive, 5 occlusion. Calcium scoring is noncontrast and predicts burden but does not exclude stenosis.
- Cardiac MRI delayed enhancement: subendocardial ischemic pattern follows a coronary territory; mid-wall or epicardial patterns suggest myocarditis, sarcoidosis, or cardiomyopathy.
Worked example
A 60-year-old with tearing chest pain undergoes CTA. A flap begins in the aortic root and extends into the arch. The false lumen is larger and less opacified. This is Stanford type A dissection, a surgical emergency; coronary malperfusion and pericardial effusion are immediate complications to report.
Traps
Missing intramural hematoma because no flap is seen; mistaking motion artifact for dissection; measuring RV/LV on an oblique plane; ignoring pericardial effusion; calling a coronary stent uninterpretable without trying to assess patency.