Findings SVC

Finding	Definition & Comment	Diagnosis	Mod	Cat	Linkable Page (Context)	Linkable Image (Game)
Congenital, PLSVC	Definition: A vertical vessel coursing through the left mediastinum, lateral to the aortic arch. Comment: Represents persistence of the embryonic Left Anterior Cardinal Vein. It typically drains into the Coronary Sinus, causing it to dilate.	Persistent Left SVC	CT/CXR	Congenital	Persistent Left SVC
Dilation, Azygos	Definition: Enlargement of the azygos vein arch > 10mm at the right tracheobronchial angle. Comment: Indicates elevated right-sided pressures or collateral flow due to SVC obstruction (downhill varices) or IVC interruption (uphill varices).	Azygos Vein Dilation	CT/CXR	Vascular	Azygos Vein Pathology
Line, Malposition	Definition: Catheter tip located outside the target SVC-RA junction (e.g., in IJV, Azygos, or too deep in RA). Comment: Requires immediate repositioning. Tips in the RA carry a risk of arrhythmia or perforation; tips in the Azygos risk rupture.	Catheter Malposition	CXR	Iatrogenic	Central Line Placement
Line, Pneumothorax	Definition: A peripheral lucency and visible visceral pleural line appearing immediately after line placement. Comment: A complication of subclavian or internal jugular vein puncture, requiring urgent assessment for tension physiology.	Iatrogenic PTX	CXR	Complication	Iatrogenic Pneumothorax
Obstruction, Malignant	Definition: Narrowing or complete occlusion of the SVC lumen by an extrinsic mass. Comment: Most commonly caused by Right Paratracheal lymphadenopathy from lung cancer or lymphoma. Leads to “SVC Syndrome” with facial edema.	SVC Syndrome	CT	Neoplasm	SVC Syndrome
Obstruction, Thrombotic	Definition: A central hypodense filling defect (“Polo Mint” sign) within the SVC. Comment: Frequently associated with indwelling catheters or pacemaker wires which serve as a nidus for clot formation.	SVC Thrombus	CT	Vascular	SVC Thrombus

Findings Right Atrium

Finding	Definition & Comment	Diagnosis	Mod	Cat	Linkable Page (Context)	Linkable Image (Game)
“Box Shaped” Heart	Definition: Massive, rectangular cardiomegaly filling the chest on frontal CXR. Comment: The classic appearance of Ebstein’s Anomaly, where the “atrialized” right ventricle creates a massive functional right atrium.	Ebstein’s Anomaly	CXR	Congenital	Ebstein’s Anomaly
Enlargement (CT)	Definition: AP diameter > 4.0 cm or width > 5.0 cm with bowing of the lateral wall. Comment: Indicates volume overload (e.g., ASD, TR) or pressure overload (PHTN). Contrast reflux into the IVC is a supportive sign.	Volume Overload / PHTN	CT	Size	Right Atrium Size
Enlargement (CXR)	Definition: Increased convexity of the right lower heart border, extending > 5.5cm from midline. Comment: The height of the border often exceeds 50% of the mediastinal vascular height. Suggests chronic right heart strain.	RA Enlargement (RAE)	CXR	Size	Frontal CXR (RAE)
Fatty Mass	Definition: A homogeneous mass of fat density (-100 HU) usually within the RAA or Crista Terminalis. Comment: Typically an Atrial Lipoma. These are benign, slow-growing, and distinct from Lipomatous Hypertrophy (which is in the septum).	Atrial Lipoma	CT/MRI	Neoplasm	Fat in Right Atrium
Filling Defect	Definition: A hypodense defect within the contrast pool, often showing a meniscus sign. Comment: Represents thrombus. Predilection for the RAA tip (stasis) or catheter tips. Must be distinguished from pectinate muscles.	RA Thrombus	CT	Pathology	RA Pathology (Thrombus)
Tumor Thrombus (HCC)	Definition: Enhancing soft tissue mass contiguous with the IVC and a hepatic mass. Comment: Represents direct invasion of Hepatocellular Carcinoma (HCC) via hepatic veins. Unlike simple clot, this mass enhances with contrast.	HCC Invasion	CT	Neoplasm	HCC Tumor Thrombus

Findings Tricuspid Valve

Finding	Definition & Comment	Diagnosis	Mod	Cat	Linkable Page (Context)	Linkable Image (Game)
Annular Dilation	Definition: Enlargement of the septal-lateral annular diameter > 40mm (or > 21mm/m²). Comment: The annulus becomes planar (losing its saddle shape), leading to malcoaptation and functional Tricuspid Regurgitation.	Functional TR	CT/Echo	Size	TV Annulus Size
Apical Displacement	Definition: Displacement of the septal leaflet insertion site > 8mm/m² toward the apex. Comment: The hallmark of Ebstein’s Anomaly. This creates a large “atrialized” ventricle and a small functional right ventricle.	Ebstein’s Anomaly	Echo/MRI	Congenital	Ebstein’s Anomaly
Leaflet Doming	Definition: Diastolic doming of the valve leaflets with restricted tip motion. Comment: Indicates commissural fusion, nearly always due to Rheumatic Heart Disease. It is rarely an isolated lesion (look at the Mitral Valve).	Tricuspid Stenosis	Echo	Inflam	Tricuspid Stenosis
Mobile Mass	Definition: An irregular, oscillating echogenic mass attached to the atrial side of the leaflet. Comment: Represents a vegetation of Infective Endocarditis. In the TV, this is strongly associated with IV drug use and septic pulmonary emboli.	Infective Endocarditis	Echo	Infection	TV Vegetation
Regurgitant Jet	Definition: A wide, high-velocity retrograde flow signal extending into the RA. Comment: Diagnostic of Tricuspid Regurgitation. Severe cases show systolic flow reversal in the hepatic veins and a dilated IVC.	Tricuspid Regurgitation	Echo	Functional	Tricuspid Regurgitation
Thickened/Fixed Leaflets	Definition: Diffuse thickening and retraction of leaflets, fixing them in a semi-open position. Comment: Classic for Carcinoid Heart Disease. The valve is both stenotic and regurgitant due to fibrous plaque deposition from serotonin exposure.	Carcinoid Heart Disease	Echo	Metabolic	Carcinoid Heart Disease

Findings Right Ventricle

Finding	Definition & Comment	Diagnosis	Mod	Cat	Linkable Page (Context)	Linkable Image (Game)
Acute Strain	Definition: Acute dilation (RV > LV) with septal flattening and contrast reflux into the IVC. Comment: The constellation of findings seen in massive Pulmonary Embolism. Indicates failing RV pump function against high afterload.	Acute Pulmonary Embolism	CT	Vascular	PE & RV Strain
Dilation (RV/LV Ratio)	Definition: RV diameter exceeding LV diameter (Ratio > 1.0) at the mid-ventricular level. Comment: The most sensitive sign of RV dysfunction. The RV loses its crescent shape and becomes circular.	RV Strain / Cor Pulmonale	CT	Size	RV Dilation (CT)
Enlargement (Triangular)	Definition: A “Triangular” or “Globular” cardiac silhouette with an uplifted apex. Comment: On lateral view, the RV fills the retrosternal clear space. Suggests chronic volume overload (e.g., ASD).	RV Enlargement (RVE)	CXR	Size / Shape	RVE on CXR
Fatty Infiltration	Definition: Replacement of the myocardial wall with fat signal (High T1) and wall thinning. Comment: Hallmark of ARVC. Affects the “Triangle of Dysplasia” (Inflow, Outflow, Apex) and predisposes to ventricular arrhythmias.	ARVC	MRI	Tissue	ARVC (MRI)
Paradoxical Septum	Definition: Leftward bowing of the septum (“D-Shaped LV”) during systole or diastole. Comment: The septum is pushed by the RV due to Pressure Overload (Systolic bowing) or Volume Overload (Diastolic flattening).	RV Pressure/Volume Overload	MRI	Functional	Septal Bounce (MRI)
Wall Motion Abnormality	Definition: Akinesis or dyskinesis of the RV free wall, often with LGE. Comment: Indicates RV Infarction, usually from proximal RCA occlusion. Highly sensitive to preload (do not give nitrates).	RV Infarction	MRI	Ischemic	RV Infarction
Wall Thickening (RVH)	Definition: Free wall thickness > 5mm with coarse trabeculations. Comment: Represents concentric hypertrophy from chronic pressure overload (e.g., Tetralogy of Fallot or Pulmonic Stenosis).	Tetralogy of Fallot	CXR / CT	Congenital	Tetralogy of Fallot

Findings Pulmonary Valve

Finding	Definition & Comment	Diagnosis	Mod	Cat	Linkable Page (Context)	Linkable Image (Game)
Dilation (MPA)	Definition: Main Pulmonary Artery diameter > 29mm (or exceeding the Aortic diameter). Comment: Indicates Pulmonary Hypertension. Often accompanied by “peripheral pruning” (rapid tapering of distal vessels).	Pulmonary Hypertension	CT	Size	Pulmonary Hypertension
Filling Defect (PE)	Definition: A central or eccentric hypodense defect within the contrast pool. Comment: The defining feature of Pulmonary Embolism. Can be described as “Polo Mint” (axial) or “Railway Track” (longitudinal).	Pulmonary Embolism	CT	Vascular	Acute Pulmonary Embolism
Fleischner Sign	Definition: Prominent, sausage-like enlargement of a central pulmonary artery (often the RDPA). Comment: A CXR sign of massive PE, caused by acute distension from the clot. Distal to the clot, the lung may appear oligemic (Westermark Sign).	Pulmonary Embolism	CXR	Sign	Fleischner Sign
Hypoplastic Artery	Definition: Diminutive or absent Main Pulmonary Artery. Comment: Seen in Pulmonary Atresia with VSD. Pulmonary blood flow is supplied by the PDA or MAPCAs (collaterals).	Pulmonary Atresia	CT / Angio	Congenital	PA Size Abnormalities
Post-Stenotic Dilation	Definition: Aneurysmal dilation of the MPA and Left PA, while the Right PA remains normal. Comment: Caused by the high-velocity jet hitting the arterial wall in Valvular Pulmonary Stenosis.	Pulmonary Stenosis	CXR / CT	Functional	PV Calcification & Dilation
Stenotic Jet (Doming)	Definition: Systolic doming of leaflets with a high velocity jet (> 4 m/s). Comment: Classic appearance of congenital Pulmonary Stenosis. The leaflets are usually thickened and dysplastic.	Pulmonary Stenosis	Echo	Congenital	Pulmonary Stenosis
Thickened/Fixed Leaflets	Definition: Diffuse thickening and retraction of leaflets causing a fixed, semi-open orifice. Comment: Characteristic of Carcinoid Heart Disease, resulting in mixed stenosis and regurgitation.	Carcinoid Heart Disease	Echo	Metabolic	Carcinoid Valve Disease

Findings Pulmonary Veins

Finding	Definition & Comment	Diagnosis	Mod	Cat	Linkable Page (Context)	Linkable Image (Game)
Anomalous Return (Scimitar)	Definition: A curvilinear vessel paralleling the right heart border (“Turkish Sword”). Comment: Scimitar Syndrome. It drains the right lung into the IVC, creating a left-to-right shunt.	Scimitar Syndrome (PAPVR)	CXR / CT	Congenital	Scimitar Syndrome
Anomalous Return (Snowman)	Definition: A “Figure of 8” or “Snowman” mediastinal silhouette. Comment: Seen in Supracardiac TAPVR. The “Head” is the dilated vertical vein and SVC; the “Body” is the heart.	TAPVR (Supracardiac)	CXR	Congenital	TAPVR (Snowman Sign)
Dilation (Cephalization)	Definition: Upper lobe vessels becoming larger in diameter than lower lobe vessels. Comment: Indicates Pulmonary Venous Hypertension (Wedge pressure > 15 mmHg) and recruitment of apical reserve vessels.	Pulmonary Venous HTN	CXR	Physiologic	Cephalization of Flow
Stenosis (Ostial)	Definition: Focal constriction of the pulmonary vein ostium at the LA junction. Comment: Often an acquired complication of Radiofrequency Ablation for A-Fib. Causes localized upstream edema.	Pulmonary Vein Stenosis	CT / MRI	Iatrogenic	Pulmonary Vein Stenosis
Varix (Focal)	Definition: A focal, saccular dilation of a pulmonary vein, usually near the LA. Comment: A benign entity (Pulmonary Varix). It enhances avidly like the blood pool and must not be mistaken for a nodule.	Pulmonary Varix	CT	Vascular	Pulmonary Varix

Findings Left Atrium

Finding	Definition & Comment	Diagnosis	Mod	Cat	Linkable Page (Context)	Linkable Image (Game)
Congenital, Cor Triatriatum	Definition: A fibromuscular membrane dividing the LA into a proximal and distal chamber. Comment: Mimics Mitral Stenosis physiology. The proximal chamber receives the veins; the distal contains the appendage and valve.	Cor Triatriatum Sinister	Echo/CT	Congenital	Cor Triatriatum
Enlargement (Carina Splaying)	Definition: Widening of the subcarinal angle (> 90 degrees) due to elevation of the LMB. Comment: A sign of massive LA enlargement (e.g., Rheumatic Valve Disease). Can create the “Walking Man” sign.	LA Enlargement (CXR)	CXR	Sign	CXR Left Atrium Signs
Enlargement (Dimensional)	Definition: AP diameter > 4.0 cm or Volume > 58 ml (Men) / > 52 ml (Women). Comment: The definitive criteria for LA enlargement. Chronic enlargement is the major substrate for Atrial Fibrillation.	LA Enlargement (CT)	CT/MRI	Size	Left Atrium Size
Enlargement (Double Density)	Definition: A curvilinear density projecting over the right heart border on frontal CXR. Comment: Represents the right lateral wall of the enlarged LA pushing into the lung. The inner density is the LA, the outer is the RA.	LA Enlargement (CXR)	CXR	Sign	Double Density Sign
Mass, Lipoma	Definition: Accumulation of non-encapsulated fat (-100 HU) in the Interatrial Septum. Comment: Lipomatous Hypertrophy. Typically spares the Fossa Ovalis, creating a “Dumbbell” shape. Benign and metabolic (obesity/elderly).	Lipomatous Hypertrophy	CT/MRI	Metabolic	Fat in Atrial Septum
Mass, Myxoma	Definition: A pedunculated, gelatinous mass attached to the Fossa Ovalis by a stalk. Comment: The most common primary cardiac tumor (benign). It is mobile and can prolapse into the mitral valve, causing obstruction.	Atrial Myxoma	Echo/MRI	Neoplasm	Atrial Myxoma
Thrombus, Appendage	Definition: A hypodense/hypointense filling defect within the LAA contrast pool. Comment: Major risk factor for stroke in Atrial Fibrillation. Must be distinguished from slow flow (smoke) or pectinate muscles.	LAA Thrombus	CT/MRI	Vascular	LAA Thrombus

Findings Mitral Valve

Finding	Definition & Comment	Diagnosis	Mod	Cat	Linkable Page (Context)	Linkable Image (Game)
Annular Calcification	Definition: Dense, “C” or “O” shaped calcification of the fibrous annulus. Comment: Mitral Annular Calcification (MAC). A degenerative process associated with aging and renal failure. Can cause conduction blocks.	Mitral Annular Calcification (MAC)	CT / CXR	Degenerative	Mitral Annular Calcification
Billowing / Prolapse	Definition: Systolic displacement of leaflet body > 2mm beyond the annular plane. Comment: Mitral Valve Prolapse (MVP). Usually affects the posterior leaflet (P2). Associated with myxomatous thickening (>5mm).	Mitral Valve Prolapse	Echo	Structural	Mitral Valve Prolapse
Parachute Deformity	Definition: Chordae from both leaflets attach to a single papillary muscle. Comment: A congenital anomaly causing a funnel-shaped stenosis. Often part of Shone’s Complex.	Parachute Mitral Valve	Echo	Congenital	Congenital MV Anomalies
Regurgitant Jet	Definition: High-velocity retrograde flow into the LA during systole. Comment: Mitral Regurgitation. Central jets suggest dilation; eccentric (wall-hugging) jets suggest leaflet pathology (e.g., flail).	Mitral Regurgitation	Echo	Functional	Mitral Regurgitation
Stenotic Doming	Definition: Diastolic “Hockey Stick” deformity of the anterior leaflet. Comment: The classic Echo sign of Rheumatic Mitral Stenosis. Caused by commissural fusion and restricted tip motion.	Mitral Stenosis	Echo	Inflam	Rheumatic Mitral Stenosis
Stenotic Orifice	Definition: “Fish-mouth” or “Button-hole” valve orifice < 1.5 cm². Comment: Seen on short-axis view. Critical stenosis (< 1.0 cm²) leads to severe pulmonary hypertension and LA enlargement.	Mitral Stenosis	Echo / MRI	Shape	Mitral Stenosis (Planimetry)
Vegetation	Definition: An oscillating, irregular echogenic mass on the atrial side of the leaflet. Comment: Infective Endocarditis. The Mitral Valve is the most common site. High risk of systemic embolization (Stroke).	Infective Endocarditis	Echo	Infection	MV Vegetation

Findings Left Ventricle

Finding	Definition & Comment	Diagnosis	Mod	Cat	Linkable Page (Context)	Linkable Image (Game)
Aneurysm, Pseudo	Definition: A contained rupture with a narrow neck (Orifice < Fundus diameter). Comment: A surgical emergency. The wall is composed only of pericardium and thrombus, carrying a high risk of rupture.	Pseudoaneurysm	CT/MRI	Emergency	LV Pseudoaneurysm
Aneurysm, True	Definition: A wide-necked, dyskinetic or akinetic outpouching, usually at the apex. Comment: A chronic sequela of transmural MI (LAD territory). The wall is thinned and scarred but intact (low rupture risk).	True LV Aneurysm	CT/MRI	Structural	LV Aneurysm
Cardiomyopathy, Dilated	Definition: Globular enlargement (LVIDd > 5.8cm) with wall thinning and poor EF (< 40%). Comment: End-stage phenotype of many insults (Viral, Alcohol, Idiopathic). Often causes secondary (functional) MR.	Dilated Cardiomyopathy	Echo/MRI	Functional	Dilated Cardiomyopathy
Cardiomyopathy, HCM	Definition: Asymmetric Septal Hypertrophy (>15mm) often with Systolic Anterior Motion (SAM). Comment: Genetic disorder of the sarcomere. Associated with patchy fibrosis (LGE) and risk of sudden cardiac death.	Hypertrophic CM (HCM)	MRI/Echo	Genetic	Hypertrophic Cardiomyopathy
Cardiomyopathy, Non-Compaction	Definition: “Spongy” myocardium with deep recesses and a Non-compacted/Compacted ratio > 2.3. Comment: Congenital arrest of myocardial compaction. Predilection for the Apex and Lateral wall.	LV Non-Compaction	MRI	Congenital	Non-Compaction
Cardiomyopathy, Takotsubo	Definition: Transient apical ballooning with basal hypercontractility (“Octopus Pot”). Comment: Stress-induced cardiomyopathy mimicking ACS but without coronary occlusion. Usually recovers fully.	Takotsubo	Ventriculogram	Stress	Takotsubo
Hypertrophy, Apical	Definition: Hypertrophy confined to the apex, creating an “Ace of Spades” cavity shape. Comment: Yamaguchi Syndrome (Asian variant of HCM). Associated with giant T-wave inversions on EKG.	Apical Hypertrophy	MRI/Angio	Shape	Apical Hypertrophy
Hypertrophy, Concentric	Definition: Symmetric wall thickening (>12mm) with a normal or small cavity. Comment: The adaptive response to chronic pressure overload (Hypertension or Aortic Stenosis). leads to diastolic dysfunction.	LV Hypertrophy (LVH)	CT/MRI	Size	LV Hypertrophy

Findings Aortic Valve

Finding	Definition & Comment	Diagnosis	Mod	Cat	Linkable Page (Context)	Linkable Image (Game)
Congenital, Bicuspid	Definition: Fusion of two cusps (usually R and L) creating a “Football” shaped orifice. Comment: The most common congenital heart defect. Associated with a Raphe, systolic doming, and ascending aortic aneurysm.	Bicuspid Aortic Valve	Echo/MRI	Congenital	Bicuspid Aortic Valve
Infection, Vegetation	Definition: An oscillating mass on the ventricular side of the leaflet. Comment: Infective Endocarditis. Can lead to leaflet perforation or perivalvular abscess.	Infective Endocarditis	Echo	Infection	Bacterial Endocarditis
Regurgitation	Definition: Diastolic retrograde flow from Aorta into LV with a Vena Contracta > 6mm. Comment: Causes LV volume overload and dilation. Acute AR (e.g., Dissection) is poorly tolerated compared to chronic.	Aortic Regurgitation	Echo/MRI	Functional	Aortic Regurgitation
Sclerosis	Definition: Focal leaflet thickening/calcification without restricted motion (Velocity < 2.5 m/s). Comment: Early degenerative change. A marker for increased cardiovascular risk but does not cause hemodynamic obstruction.	Aortic Sclerosis	Echo	Degenerative	Aortic Sclerosis
Stenosis, Calcific	Definition: Severe calcification limiting cusp motion, with valve area < 1.0 cm². Comment: Degenerative AS (Senile). Causes concentric LV hypertrophy due to pressure overload.	Aortic Stenosis	CT/Echo	Degenerative	Aortic Stenosis
Stenosis, Rheumatic	Definition: Commissural fusion causing a triangular systolic orifice. Comment: Rheumatic AS. Unlike calcific AS, this involves the commissures. Almost always accompanied by Mitral Valve disease.	Rheumatic AS	Echo	Inflam	Rheumatic Aortic Stenosis

Findings Ascending Aorta

Finding	Definition & Comment	Diagnosis	Mod	Cat	Linkable Page (Context)	Linkable Image (Game)
Aneurysm, Ascending	Definition: Fusiform dilation of the tubular aorta > 4.0 cm (or > 2.1 cm/m²). Comment: Associated with hypertension (degenerative) or connective tissue disease. Risk of rupture or dissection increases with size.	Ascending Aortic Aneurysm	CT/MRI	Size	Thoracic Aneurysm
Aneurysm, Root (Ectasia)	Definition: Dilation of the Sinuses of Valsalva with effacement of the sinotubular junction. Comment: “Tulip Bulb” deformity (Annuloaortic Ectasia). Classic for Marfan Syndrome and causes severe Aortic Regurgitation.	Root Aneurysm	CT/MRI	Genetic	Annuloaortic Ectasia
Coarctation	Definition: Focal narrowing of the aortic isthmus with “3 Sign” (pre/post-stenotic dilation). Comment: Congenital lesion. Causes hypertension in arms > legs and development of collateral vessels (Rib Notching).	Aortic Coarctation	CT/CXR	Congenital	Aortic Coarctation
Dissection, Type A	Definition: Intimal flap involving the Ascending Aorta (Proximal). Comment: A surgical emergency due to risk of tamponade, coronary occlusion, or acute severe AR.	Type A Dissection	CT Angio	Emergency	Aortic Dissection (Type A)
Dissection, Type B	Definition: Intimal flap involving the Descending Aorta (distal to Left Subclavian). Comment: Typically managed medically unless there is malperfusion (gut/kidney ischemia) or rupture.	Type B Dissection	CT Angio	Vascular	Aortic Dissection (Type B)
Hematoma, Intramural	Definition: Crescentic, high-density wall thickening (>5mm) without an intimal flap. Comment: Represents hemorrhage into the media (vasa vasorum rupture). A precursor to frank dissection and treated similarly.	Intramural Hematoma (IMH)	CT (Non-Con)	Emergency	Intramural Hematoma
Transection (Traumatic)	Definition: Contour irregularity or pseudoaneurysm at the Aortic Isthmus. Comment: Result of rapid deceleration injury. The ligamentum arteriosum acts as a tethering point, causing the tear.	Traumatic Aortic Injury	CT Angio	Trauma	Traumatic Aortic Injury
Ulcer, Penetrating (PAU)	Definition: Focal crater-like outpouching extending beyond the intima into the media. Comment: Occurs in severe atherosclerosis. Can progress to IMH, dissection, or rupture (Acute Aortic Syndrome).	Penetrating Aortic Ulcer	CT Angio	Emergency	Penetrating Ulcer (PAU)