Congenital Cardiovascular Disease in the Adult Patient

Asymmetrical Hilar Enlargement in an Asymptomatic Patient

“…A large central pulmonary embolus in the left main pulmonary artery can also produce asymmetric pulmonary blood flow leading to unilateral enlargement i.e Fleischner sign; however, absence of other radiographic features such as wedge-shaped focal infarcts (Hamptom hump) and oligemia (Westermark sign) in an asymptomatic individual makes this an unlikely diagnosis [1,2].…”

“…In some cases, enlargement of the main pulmonary artery can also be appreciated, as well as right ventricular enlargement in severe cases. Asymmetric enlargement of the left compared with the normal right pulmonary artery is the "auntminnie" characteristic of this condition.A large central pulmonary embolus in the left main pulmonary artery can also produce asymmetric pulmonary blood flow leading to unilateral enlargement i.e Fleischner sign; however, absence of other radiographic features such as wedge-shaped focal infarcts (Hamptom hump) and oligemia (Westermark sign) in an asymptomatic individual makes this an unlikely diagnosis [1,2].Hypoplasia of the right pulmonary artery may be considered in view of the asymmetry. However, pulmonary artery hypoplasia is classically associated with lung hypoplasia and possibly dextroversion or anomalous pulmonary venous trunk in cases of Scimitar syndrome; a normal appearing right lung excludes this diagnosis.…”

Computed tomography for the diagnosis of congenital heart disease in pediatric and adult patients

“…In Ebstein anomaly, various degrees of downward displacement of the septal and posterior leaflets of the tricuspid valve into the right ventricle are observed, and the right ventricle is therefore divided into atrialized and functioning portions [1,6]. In a severe case of Ebstein anomaly, the large anterior leaflet may show fibrous adhesion to the right ventricular free wall ( Figure 16).…”

“…As a result, varying degrees of tricuspid stenosis develop in addition to tricuspid regurgitation, and the capacity of the functioning right ventricle is reduced by the aneurysmally dilated atrialized right ventricle. There are many congenital mitral valve diseases, including parachute mitral valve and mitral valve prolapse, which may cause stenosis, regurgitation, or both [6]. Abnormal appearances of the mitral valve can be evaluated by ECG-gated multi-slice CT [4].…”

“…When coupled with electrocardiography (ECG)-gating and dedicated cardiac reconstruction algorithms, multi-slice spiral CT can be used to obtain functional data, including ventricular wall motion, ventricular ejection fraction, and motion of the cardiac valves, and to morphologically evaluate rapidly moving intracardiac or paracardiac structures, including the coronary artery [2][3][4][5]. The number of adult patients with corrected congenital heart disease who need CT or MR imaging for early detection of complications has been increasing, due to improvements in surgical techniques, other interventions, and perioperative care [6]. In this article, we describe the optimal CT techniques and imaging findings in pediatric and adult patients with various congenital heart diseases.…”