Skip to main content
SpringerLink
Log in

Normal variations and anatomic pitfalls that may mimic diseases on coronary CT angiography

  • Original Paper
  • Published:
The International Journal of Cardiovascular Imaging Aims and scope Submit manuscript

Abstract

The aim of this study was to review the normal variations and anatomic pitfalls that may mimic diseases on coronary computed tomography angiography (CCTA), based on an echocardiographic correlation. Diverse normal variations and anatomic pitfalls of the heart can be misinterpreted as pathologic processes on radiologic examination. Awareness of normal variations and anatomic pitfalls during CCTA will help avoid misinterpretation of CCTA findings.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13
Fig. 14
Fig. 15
Fig. 16
Fig. 17
Fig. 18

Similar content being viewed by others

References

  1. Hong C, Becker CR, Huber A et al (2001) ECG-gated reconstructed multi-detector row CT coronary angiography: effect of varying trigger delay on image quality. Radiology 220(3):712–717

    Article  CAS  PubMed  Google Scholar 

  2. Kim EY, Choe YH, Sung K et al (2009) Multidetector CT and MR imaging of cardiac tumors. Korean J Radiol 10(2):164–175

    Article  PubMed  Google Scholar 

  3. Broderick LS, Brooks GN, Kuhlman JE (2005) Anatomic pitfalls of the heart and pericardium. Radiographics 25(2):441–453

    Article  PubMed  Google Scholar 

  4. Halpern EJ (2008) Cardiac morphology and function. In: Halpern EJ (ed) Clinical cardiac CT: anatomy and function. Thieme, pp 146–177

  5. Feigenbaum H, Armstrong WF, Ryan T (2005) Masses, tumors, and source of embolus. In: Feigenbaum’s echocardiography. Lippincott Williams & Wilkins, Philadelphia, pp 701–733

  6. Gaudio C, Di Michele S, Cera M (2004) Prominent crista terminalis mimicking a right atrial mixoma: cardiac magnetic resonance aspects. Eur Rev Med Pharmacol Sci 8(4):165–168

    CAS  PubMed  Google Scholar 

  7. Wong PC, Sanders SP, Jonas RA et al (1991) Pulmonary valve-moderator band distance and association with development of double-chambered right ventricle. Am J Cardiol 68(17):1681–1686

    Article  CAS  PubMed  Google Scholar 

  8. Kim E, Choe YH, Han BK et al (2007) Right ventricular fat infiltration in asymptomatic subjects: observations from ECG-gated 16-slice multidetector CT. J Comput Assist Tomogr 31(1):22–28

    Article  PubMed  Google Scholar 

  9. Gonzalez-Juanatey C, Testa A, Vidan J et al (2004) Persistent left superior vena cava draining into the coronary sinus: report of 10 cases and literature review. Clin Cardiol 27(9):515–518

    Article  PubMed  Google Scholar 

  10. Duerinckx AJ, Vanovermeire O (2008) Accessory appendages of the left atrium as seen during 64-slice coronary CT angiography. Int J Cardiovasc Imaging 24(2):215–221

    Article  PubMed  Google Scholar 

  11. Kim YY, Klein AL, Halliburton SS et al (2007) Left atrial appendage filling defects identified by multidetector computed tomography in patients undergoing radiofrequency pulmonary vein antral isolation: a comparison with transesophageal echocardiography. Am Heart J 154(6):1199–1205

    Article  PubMed  Google Scholar 

  12. Lacomis JM, Wigginton W, Fuhrman C et al (2003) Multi-detector row CT of the left atrium and pulmonary veins before radio-frequency catheter ablation for atrial fibrillation. Radiographics 23:S35–S48

    Article  PubMed  Google Scholar 

  13. Lekkerkerker JC, Jaarsma W, Cramer MJ (2005) Congenital giant aneurysm of the left atrial appendage. Heart 91(3):e21

    Article  CAS  PubMed  Google Scholar 

  14. Lichtenberg J, Briza J, Holm F (1995) Aneurysms of the left atrium and left atrial appendage. Cas Lek Cesk 134(7):207–208 [Czech]

    CAS  PubMed  Google Scholar 

  15. Mathur A, Zehr KJ, Sinak LJ, Rea RF (2005) Left atrial appendage aneurysm. Ann Thorac Surg 79(4):1392–1393

    Article  PubMed  Google Scholar 

  16. Terada H, Tanaka Y, Kashima K et al (2000) Left atrial diverticulum associated with severe mitral regurgitation. Jpn Circ J 64(6):474–476

    Article  CAS  PubMed  Google Scholar 

  17. Veinot JP, Harrity PJ, Gentile F et al (1997) Anatomy of the normal left atrial appendage: a quantitative study of age-related changes in 500 autopsy hearts: implications for echocardiographic examination. Circulation 96(9):3112–3115

    CAS  PubMed  Google Scholar 

  18. Harloff A, Handke M, Reinhard M et al (2006) Therapeutic strategies after examination by transesophageal echocardiography in 503 patients with ischemic stroke. Stroke 37(3):859–864

    Article  PubMed  Google Scholar 

  19. Hur J, Kim YJ, Lee HJ et al (2009) Left atrial appendage thrombi in stroke patients: detection with two-phase cardiac CT angiography versus transesophageal echocardiography. Radiology 251(3):683–690

    Article  PubMed  Google Scholar 

  20. Berkompas DC, Sagar KB (1994) Accuracy of color Doppler transesophageal echocardiography for diagnosis of patent foramen ovale. J Am Soc Echocardiogr 7(3 Pt 1):253–256

    CAS  PubMed  Google Scholar 

  21. Saremi F, Channual S, Raney A et al (2008) Imaging of patent foramen ovale with 64-section multidetector CT. Radiology 249(2):483–492

    Article  PubMed  Google Scholar 

  22. Manning WJ, Waksmonski CA, Riley MF (1992) Remnant of the common pulmonary vein mistaken for a left atrial mass: clarification by transoesophageal echocardiography. Br Heart J 68(1):4–5

    Article  CAS  PubMed  Google Scholar 

  23. Oh JK, Seward JB, Tajik AJ (1999) Appendix. In: The echo manual. Lippincott Williams & Wilkins, Philadelphia, pp 257–265

  24. Baosheng G, Jun Y, Xiaona Y et al (2009) Left ventricular apical thin point viewed with two-dimensional echocardiography. Echocardiography 26(8):988–990

    Article  PubMed  Google Scholar 

  25. Bradfield JW, Beck G, Vecht RJ (1977) Left ventricular apical thin point. Br Heart J 39(7):806–809

    Article  CAS  PubMed  Google Scholar 

  26. Johnson KM, Johnson HE, Dowe DA (2009) Left ventricular apical thinning as normal anatomy. J Comput Assist Tomogr 33(3):334–337

    Article  PubMed  Google Scholar 

  27. Keren A, Billingham ME, Popp RL (1984) Echocardiographic recognition and implications of ventricular hypertrophic trabeculations and aberrant bands. Circulation 70(5):836–842

    CAS  PubMed  Google Scholar 

  28. Boyd MT, Seward JB, Tajik AJ et al (1987) Frequency and location of prominent left ventricular trabeculations at autopsy in 474 normal human hearts: implications for evaluation of mural thrombi by two-dimensional echocardiography. J Am Coll Cardiol 9(2):323–326

    Article  CAS  PubMed  Google Scholar 

  29. Sedmera D, Pexieder T, Vuillemin M et al (2000) Developmental patterning of the myocardium. Anat Rec 258(4):319–337

    Article  CAS  PubMed  Google Scholar 

  30. Tamborini G, Pepi M, Celeste F et al (2004) Incidence and characteristics of left ventricular false tendons and trabeculations in the normal and pathologic heart by second harmonic echocardiography. J Am Soc Echocardiogr 17(4):367–374

    Article  PubMed  Google Scholar 

  31. Alhabshan F, Smallhorn JF, Golding F et al (2005) Extent of myocardial non-compaction: comparison between MRI and echocardiographic evaluation. Pediatr Radiol 35(11):1147–1151

    Article  PubMed  Google Scholar 

  32. Oechslin EN, Attenhofer Jost CH, Rojas JR et al (2000) Long-term follow-up of 34 adults with isolated left ventricular noncompaction: a distinct cardiomyopathy with poor prognosis. J Am Coll Cardiol 36(2):493–500

    Article  CAS  PubMed  Google Scholar 

  33. Ritter M, Oechslin E, Sütsch G et al (1997) Isolated noncompaction of the myocardium in adults. Mayo Clin Proc 72(1):26–31

    Article  CAS  PubMed  Google Scholar 

  34. Petersen SE, Selvanayagam JB, Wiesmann F et al (2005) Left ventricular non-compaction: insights from cardiovascular magnetic resonance imaging. J Am Coll Cardiol 46(1):101–105

    Article  PubMed  Google Scholar 

  35. Luetmer PH, Edwards WD, Seward JB et al (1986) Incidence and distribution of left ventricular false tendons: an autopsy study of 483 normal human hearts. J Am Coll Cardiol 8(1):179–183

    Article  CAS  PubMed  Google Scholar 

  36. Mattioli AV, Aquilina M, Oldani A et al (2001) Atrial septal aneurysm as a cardioembolic source in adult patients with stroke and normal carotid arteries. A multicentre study. Eur Heart J 22(3):261–268

    Article  CAS  PubMed  Google Scholar 

  37. Gaerte SC, Meyer CA, Winer-Muram HT et al (2002) Fat-containing lesions of the chest. Radiographics 22:S61–S78

    PubMed  Google Scholar 

  38. Meaney JF, Kazerooni EA, Jamadar DA et al (1997) CT appearance of lipomatous hypertrophy of the interatrial septum. AJR Am J Roentgenol 168(4):1081–1084

    CAS  PubMed  Google Scholar 

  39. Zeebregts CJ, Hensens AG, Timmermans J et al (1997) Lipomatous hypertrophy of the interatrial septum: indication for surgery? Eur J Cardiothorac Surg 11(4):785–787

    Article  CAS  PubMed  Google Scholar 

  40. Choi YW, McAdams HP, Jeon SC et al (2000) The “High-Riding” superior pericardial recess: CT findings. AJR Am J Roentgenol 175(4):1025–1028

    CAS  PubMed  Google Scholar 

  41. Glazer HS, Siegel MJ, Sagel SS (1989) Low-attenuation mediastinal masses on CT. AJR Am J Roentgenol 152(6):1173–1177

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, Gachon University Gil Hospital, Incheon, Korea

    Eun Young Kim

  2. Department of Radiology and Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Gangnam-Gu, Seoul, 135-710, Korea

    Jong Heon Park & Yeon Hyeon Choe

  3. Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

    Sang-Chol Lee

Authors
  1. Eun Young Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jong Heon Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yeon Hyeon Choe
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sang-Chol Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yeon Hyeon Choe.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kim, E.Y., Park, J.H., Choe, Y.H. et al. Normal variations and anatomic pitfalls that may mimic diseases on coronary CT angiography. Int J Cardiovasc Imaging 26 (Suppl 2), 281–294 (2010). https://doi.org/10.1007/s10554-010-9707-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10554-010-9707-z

Keywords

Search

Navigation