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