Imaging
Pulmonary Stenosis
- Preliminary Diagnosis: Pulmonary Stenosis
-
I. What imaging technique is first-line for this diagnosis?
- II. Describe the advantages and disadvantages of this technique for diagnosing pulmonary stenosis.
-
III. What are the contraindications for the first-line imaging technique?
-
IV. What alternative imaging techniques are available?
- V. Describe the advantages and disadvantages of the alternative techniques for diagnosing pulmonary stenosis.
- VI. What are the contraindications for the alternative imaging techniques?
Preliminary Diagnosis: Pulmonary Stenosis
I. What imaging technique is first-line for this diagnosis?
Trans-thoracic 2D echocardiography.
II. Describe the advantages and disadvantages of this technique for diagnosing pulmonary stenosis.
Advantages
Offers exquisite anatomical and functional imaging.
Does not expose patients to ionizing radiation.
Helps detect pressure gradients and velocities across a diseased valve and helps guide treatment.
Disadvantages
Operator dependent.
III. What are the contraindications for the first-line imaging technique?
No specific contraindications exist.
IV. What alternative imaging techniques are available?
PA and lateral view of the chest.
CTA.
MR/MRA of the heart.
Conventional cardiac catheter angiography.
V. Describe the advantages and disadvantages of the alternative techniques for diagnosing pulmonary stenosis.
PA and lateral view of the chest
Advantages
Relatively inexpensive, portable imaging modality.
Exposes patients to negligible ionizing radiation.
Disadvantages
Moderately sensitive and poorly specific in detecting and diagnosing pulmonary stenosis.
Does not allow for adequate delineation of the surrounding anatomical structures.
CTA
Advantages
Offers exquisite detail of the anatomical structures, including vascular, soft tissue, lymphatic, and osseous structures.
Disadvantages
Exposes patients to ionizing radiation.
Does not allow for therapeutic intervention.
Useful for evaluating supravalvular and peripheral pulmonary stenosis.
MR/MRA of the heart
Advantages
Does not expose patients to ionizing radiation.
Useful for evaluating supravalvular and peripheral pulmonary stenosis.
Disadvantages
Expensive.
Time consuming.
Offers less exquisite detail of the surrounding vascular structures.
May be subject to motion and susceptibility weighted image artifact.
Must be cardiac gated.
Conventional cardiac catheter angiography
Advantages
Offers exquisite detail of the cardiac valvular architecture and helps detect any other coexisting abnormalities.
Allows for diagnosis and therapeutic intervention simultaneously.
Disadvantages
Exposes patients to greater morbidity and mortality secondary to the invasive nature of the exam.
Exposes patients to large amounts of ionizing radiation.
VI. What are the contraindications for the alternative imaging techniques?
PA and lateral view of the chest
No specific contraindication. Some institutions may have pregnant patients sign consent
CTA
May be contraindicated in pregnant patients.
Relative contraindication in patients with renal failure and contrast allergy
MR/MRA of the heart
Contraindicated in patients with non-MR compatible hardware.
Conventional cardiac catheter angiography
Contraindicated in patients who are in a severe hypocoaguable state.
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