Critical Findings

in Cardiac CT
Angiography
D R . D R. RU S L I MU L J A D I S P. R A D ( K )
S I L O A M H O S P I TA L L I P P O V I L L A G E
FA C U LT Y O F ME D I C I N E P E L I TA H A R A PA N U N I V E R S I T Y
REPORTING
Plaque charateristics: Effect on lumen

• Calcified ◦ Positive remodeling

• Non-calcified ◦ Minimal luminal narrowing

• Mixed ◦ Mild luminal narrowing (<50%)

◦ Moderate luminal narrowing (51-

70%)

◦ Significant stenosis (>70%)

CCTA
Qualitative – Eye Ball
Case 1
M, 58 YO
MEDICAL CHECK UP

CRITICAL ? T/F
DIASTOLE 75% SYSTOLE 40%
Confirmation another phase

Christoph A. Karlo et al. Insights Imaging (2012) 3:215–228

Christoph A. Karlo et al. Insights Imaging (2012) 3:215–228
Christoph A. Karlo et al. Insights Imaging (2012) 3:215–228
Christoph A. Karlo et al. Insights Imaging (2012) 3:215–228
Case 2. Medical Check Up
Critical ? T/F
Case 2. Positive Remodeling Soft Plaque
with Ulceration
VULNERABLE PLAQUES CCTA.

(A) positive remodeling (B) low-attenuation plaque

(C) spotty calcification (D) the “napkin ring” sign

Michelle C. Williams et al. JACC 2019;73:291-301
2019 The Authors
Plaque disruption with superimposed thrombus formation is the proximate cause of acute coronary
syndromes (ACS).

Invasive coronary imaging is the gold standard for detection of disrupted plaques, the angiographic
hallmark a “complex” lesion characterized by “Ambrose criteria” including haziness, ulceration,
intraplaque dye penetration and intraluminal filling defects.

Ryan D. Madder et al. Circulation 2011

Ryan D. Madder et al. Circulation 2011
Gilles Rioufol et al. Circulation 2004
Case 3.Medical Check up
Critical ? T/F ?
 Case 3.Anomali origin, interarterial
course
Anomali origin, interarterial course
 CORONARY ARTERY ANOMALY ORIGIN
Which Malignant ?
A B C
Radiology Assistant
Radiology Assistant
Case 4. M, 60 yo. Hx MCI
Critical ?
oklusi pada segmen mid LAD akibat mixed plaque sepanjang ±1,9 cm
oklusi pada segmen mid LAD akibat mixed plaque sepanjang ±1,9 cm
Case 4. VSD as a complication of myocardial
infarct

ventricular septal defect

ventricular septal defect
1
KOMPLIKASI INFARK
MIOKARD 1
1. Ruptur Dinding Ventrikular
Akut ➝ Kolaps hemodinamik mendadak
Subakut ➝ Efusi perikardial ➝ Hematoma
 1 Ruptur Dinding Ventrikular

E ➝ Efusi Ruptur dinding posterolateral ventrikel

perikardial
kiri

Brenes JA, Keifer T, Karim RM, Shroff GR. Adjuvant Role of CT in the Diagnosis of Post-Infarction Left Ventricular Free-Wall Rupture. Cardiol Res.
2012;3(6):284-287
 KOMPLIKASI INFARK MIOKARD
2
2 Ventricular Septal Defect
Abnormalitas pembukaan septum
➝ Shunting antar ventrikel

X-Ray ➝ Kardiomegali &

vaskularisasi paru ↑

CT ➝ Pembesaran atrium kiri &

ukuran aorta normal

 2 Ventricular Septal Defect

Kardiomegali & Vaskularisasi ↑ VSD di anterior

Subarterial VSD

Rojas CA, Jaimes C, Abbara S. Journal of Thoracic Imaging: Ventricular Septal Defects Embryology and
Imaging Findings. 2013;28(2):W28-34
KOMPLIKASI INFARK MIOKARD
3
3
Pseudoaneurisma
Nyeri dada

Gagal jantung

Volume

overload Transesofageal echo

Murmur MRI CT
 3 Pseudoaneurisma

Lesi fokal, menonjol seperti kantung pada dinding lateral

Pseudoaneurisma pada ventrikel
pada segmen pertengahan pada ventrikel kiri
kiri dengan batas yang jelas
Kim MN, Park SM, Kim SW, et al. Progression of left ventricular pseudoaneurysm after an acute myocardial infarction. J
Cardiovasc Ultrasound. 2010;18(4):161-164
Left Ventricular Aneurysm
Calcification myocard and aneurysm

Linda C. Chu. AJR 2014

 KOMPLIKASI INFARKMIOKARD
4
4
Regurgitasi Mitral Akut
Organik ➝ Gangguan struktural permanen
Fungsional ➝ Abnormalitas ventrikel kiri
 4 Regurgitasi Mitral Akut

Echo ➝ Regurgitasi berat &

ukuran ventrikel kiri normal

Regurgitasi mitral berat Ukuran ventrikel kiri normal

Stout K, Verrier E. Acute Valvular Regurgitation. American Heart Association. 2009;119:3232-41

Infark Acute myocardial infarct Chronic subendocardial myocard infarct
Myocardium

Chronic transmural myocardial infarct Left ventricular aneurysm

Case 6. Infark Myocardium
Deepest muscle is last supplied & 1st to die
◦ subendocardial infarct

In 3-6 hours, can enlarge to involve the full

thickness of the ventricular wall
◦ transmural infarct
Acute Chronic
Case 5. M, Dispnoe
Critical ? T/F ?
Case 5. Trombus Ventrikel Kiri
Left Auricular Thrombus
Thrombus in Right Atrium
Thrombus in Right Atrium extend to PE
Left Atrial Tumor (Myxoma?)
Case 6. F, 50 yo Dyspnoe
Case 6. Hematopericardium
Be Carefull, It is not pericarditis
 Hemopericardium
Pericardial cyst

Linda C. Chu. AJR 2014

Case 7
F, 69 Tahun
Chest Pain
Normal Troponin
No ST Elevation
Pulmonary Emboli
THANK YOU