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Bicuspid Aortic Valve with Aortic Stenosis and Aortic Dilatation.

Patterson RAP - MedPix (2006)

View Article: MedPix Image - MedPix Case

Affiliation: Uniformed Services University

ABSTRACT

Diagnosis: Bicuspid Aortic Valve with Aortic Stenosis and Aortic Dilatation.

History: 38-year-old man with heart murmur on physical exam.

Findings: On axial (Figure A) and sagittal (Figure B) black blood DIR FSE images, the patient is noted to have a dilated ascending aorta, which measures approximately 48 mm in diameter. Steady state free precession is a relatively newer MR pulse sequence that provides good homogeneity of the bright blood pool signal and confirms the aortic dilatation noted on black blood images (Figures C and D). On cine bright blood MR using fast gradient echo imaging, a distinctive systolic flow jet (Figure E, arrow) is noted which arises from the posterior aortic valve into the ascending aorta. This moderate to large jet is consistent with moderate to severe aortic stenosis. No diastolic jet to suggest aortic insufficiency was seen (not shown). On cine bright blood phase contrast imaging at the level of the aortic valve, the aortic valve orifice is noted to be lens shaped (Figure F, arrowheads). Contrast-enhanced three-dimensional MRA (Figure G) confirmed the dilated ascending aortic root and absence of an aortic dissection or coarctation.

Ddx: Ascending Aortic Dilatation: 1) Atheroscloerosis 2) Aortic valvular disease (stenosis and/or insufficiency 3) Collagen vascular disease (e.g. Marfan syndrome) 4) Mycotic aneurysm 5) Aortic dissection

Dxhow: MRI

Exam: Electrocardiogram (ECG)-gated MR of the chest was performed and included axial (Figure A) and sagittal (Figure B) black blood double inversion recovery fast spin echo (DIR FSE) and axial (Figure C) and sagittal (Figure D) bright blood fast steady state free precession images. Oblique sagittal cine bright blood fast gradient echo images (Figure E, select systolic images) were performed parallel to the long axis of the aortic root. Oblique axial bright blood cine phase contrast images (Figure F, select serial systolic images) through the base of the heart through the aortic valve plane were also performed.

No MeSH data available.


Figure D. Sagittal SSFP On DIR FSE images (A, axial; B, sagittal), dilation of the ascending aorta to 4.8 cm is well seen.  This is confirmed on corresponding bright blood images (C, axial; D, sagittal) performed using a steady state free precession pulse sequence.  Ao = ascending aorta
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MPX2218_synpic30797: Figure D. Sagittal SSFP On DIR FSE images (A, axial; B, sagittal), dilation of the ascending aorta to 4.8 cm is well seen. This is confirmed on corresponding bright blood images (C, axial; D, sagittal) performed using a steady state free precession pulse sequence. Ao = ascending aorta


Bicuspid Aortic Valve with Aortic Stenosis and Aortic Dilatation.

Patterson RAP - MedPix (2006)

Figure D. Sagittal SSFP On DIR FSE images (A, axial; B, sagittal), dilation of the ascending aorta to 4.8 cm is well seen.  This is confirmed on corresponding bright blood images (C, axial; D, sagittal) performed using a steady state free precession pulse sequence.  Ao = ascending aorta
© Copyright Policy - open-access
Related In: Results  -  Collection

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MPX2218_synpic30797: Figure D. Sagittal SSFP On DIR FSE images (A, axial; B, sagittal), dilation of the ascending aorta to 4.8 cm is well seen. This is confirmed on corresponding bright blood images (C, axial; D, sagittal) performed using a steady state free precession pulse sequence. Ao = ascending aorta

View Article: MedPix Image - MedPix Case

Affiliation: Uniformed Services University

ABSTRACT

Diagnosis: Bicuspid Aortic Valve with Aortic Stenosis and Aortic Dilatation.

History: 38-year-old man with heart murmur on physical exam.

Findings: On axial (Figure A) and sagittal (Figure B) black blood DIR FSE images, the patient is noted to have a dilated ascending aorta, which measures approximately 48 mm in diameter. Steady state free precession is a relatively newer MR pulse sequence that provides good homogeneity of the bright blood pool signal and confirms the aortic dilatation noted on black blood images (Figures C and D). On cine bright blood MR using fast gradient echo imaging, a distinctive systolic flow jet (Figure E, arrow) is noted which arises from the posterior aortic valve into the ascending aorta. This moderate to large jet is consistent with moderate to severe aortic stenosis. No diastolic jet to suggest aortic insufficiency was seen (not shown). On cine bright blood phase contrast imaging at the level of the aortic valve, the aortic valve orifice is noted to be lens shaped (Figure F, arrowheads). Contrast-enhanced three-dimensional MRA (Figure G) confirmed the dilated ascending aortic root and absence of an aortic dissection or coarctation.

Ddx: Ascending Aortic Dilatation: 1) Atheroscloerosis 2) Aortic valvular disease (stenosis and/or insufficiency 3) Collagen vascular disease (e.g. Marfan syndrome) 4) Mycotic aneurysm 5) Aortic dissection

Dxhow: MRI

Exam: Electrocardiogram (ECG)-gated MR of the chest was performed and included axial (Figure A) and sagittal (Figure B) black blood double inversion recovery fast spin echo (DIR FSE) and axial (Figure C) and sagittal (Figure D) bright blood fast steady state free precession images. Oblique sagittal cine bright blood fast gradient echo images (Figure E, select systolic images) were performed parallel to the long axis of the aortic root. Oblique axial bright blood cine phase contrast images (Figure F, select serial systolic images) through the base of the heart through the aortic valve plane were also performed.

No MeSH data available.