Innovation Health Services

🫀 Unknown Case A 74-year-old man presents with persistent bacteremia following TAVR. What are the imaging findings and what’s the most likely diagnosis? #Medtwitter #Cardiotwitter #RadRes #Radiology #Cardiology

🫀 Unknown Cardiac CT Case A patient undergoes coronary CTA for evaluation of exertional chest pain. The coronary arteries are enlarged and tortuous, but one critical vessel isn’t arising from where you expect it… ❓What is the diagnosis? #Radres #Radiology #Cardiology

🫀 Diagnosis: Chronic bridging thrombus of the left atrium following orthotopic heart transplantation. This uncommon entity forms across the surgical anastomosis between the donor and retained native left atrium. Recognition is important because it can remain stable for years and should not be mistaken for a new intracardiac mass or embolic thrombus requiring intervention. The key to the diagnosis? 📍Know the transplant anatomy and compare with prior imaging. Have you ever encountered one? #Cardiotwitter #Cardiology #Radiology #Radtwitter

🫀 Unknown Case A patient with a history of orthotopic heart transplantation undergoes contrast-enhanced CT for evaluation of persistent cardiac findings. ❓What is the diagnosis? 💡 Hint: Knowledge of the surgical technique used in heart transplantation is critical. Not every intracardiac filling defect represents tumor or acute thrombus. #Cardiology #Radiology #Medtwitter

🚨 Can't Miss Case 🚨 A 62-year-old presents with sudden-onset chest pain radiating to the back. Echocardiography reveals an unexpected finding. What’s the most important diagnosis to consider, and what imaging finding gives it away? 🔍 Bonus question: What is the next best step in management? #Radiology #Cardiology #MedTwitter #CardioTwitter

🫀 What a great case! 70-year-old woman with metastatic [withheld]. What’s the diagnosis? 🤔 Check out the full blog post: shorturl.at/xhuit #Radres #Cardiology #RadTwitter #CardiacMRI #MedEd

Practical takeaways 🖥️ Use CT for follow-up 🔍 Look beyond gradients 💊 Consider anticoagulation in high-risk HALT, particularly if associated with symptoms, thromboembolic complications, or deteriorating hemodynamics 🔁 Re-image when it matters

3⃣ Context matters. Impact on long-term outcomes is still debated, so a tailored approach to screening for HALT is necessary. Routine CTA is not recommended for all but should be considered around 30 days post-TAVR for high-risk individuals.

🧵 HALT: the CT finding you can’t ignore after transcatheter aortic valve replacement (TAVR). Hypoattenuated leaflet thickening (HALT) = subclinical leaflet thrombosis. Best seen on cardiac CT. And yes – it matters. #Cardiology #Radiology #Radres #Medtwitter

🫀 Answer Reveal | The floppy septum strikes back This is an atrial septal aneurysm. That exaggerated, redundant bowing of the interatrial septum = not just a vibe… it moves 🌊 🎯 Key implications: – Often incidental…but 👀 – Associated with PFO – Potential embolic source (hello cryptogenic stroke) #Radiology #Medtwitter #Radres #Cardiology

🫀 Unknown Case | Cardiac CT Incidental finding… or future problem? 👀 💭 What’s going on here? Drop your diagnosis ⬇️ #Radiology #Cardiology #Radres #Medtwitter

🫀 Answer Reveal | It’s constrictive pericarditis. Those dense pericardial calcifications aren’t just decorative—they’re a rigid cage around the heart 🪨➡️🫀 🚫 Impaired diastolic filling 📉 Equalization of pressures ⬆️ Right heart failure symptoms If the heart can’t expand… it can’t function. #Radres #Radiology #Cardiology #Medtwitter

🫀 Unknown Case | Cardiac CT Chronic chest pain. Progressive right heart dysfunction. CT shows something subtle but sinister 👇 What’s the diagnosis? 💭 Think about: – Pericardium vs myocardium – Diastolic filling problem – Why the RV is struggling Drop your guess ⬇️ #Radiology #Cardiology #Radres #Medtwitter

💥 ANSWER: This heart got… impaled. 💥 👉 IVC filter strut embolization/penetration 👉 Causing an interventricular septal hematoma + partial septal dissection Yes… an IVC filter tine migrated along the IVC and straight into the septum 😳 📈 Chest pain + elevated troponins = mechanical myocardial injury in this case, not plaque rupture 🫠 Rare. Wild. Absolutely unforgettable CT diagnosis #Radres #Radiology #Medtwitter

🚨 CHAOS CASE ALERT 🚨 23:59 vibes. Chest pain. Troponins climbing. Everyone thinking ACS… …but then the cardiac CT drops 😳 👉 Interventricular septum = 👎 👉 And wait… is that a foreign body piercing the septum?! 💀 Something has literally stabbed the heart from the venous side What is going on here?! 🫢😱 #Medtwitter #Radiology #Cardiology #Radres

🚨 ANSWER DROP 🚨 It’s aortic coarctation. a.k.a. when the aorta said: “✨I will be narrowing… right here… for dramatic effect✨” 💡 Clues that gave it away: • Focal narrowing at the proximal descending aorta (classic spot 👀) • Mild post-stenotic dilation = pressure party downstream • Collaterals absolutely jacked → intercostals putting in OT Bonus trivia for the real ones: Rib notching on CXR = the collaterals have been grinding for YEARS 💪 #RadTwitter #CardiacImaging #MedEd

👦23 y/o. “Known congenital abnormality.” That’s it. That’s the history. 😅 You open the scan and immediately feel like the aorta is… being extra. What’s the diagnosis?? Wrong answers encouraged. Confidence required. ⬇️⬇️⬇️ #RadTwitter #CardioTwitter #Radres #MedEd #WhyIsTheAortaLikeThis