(精选)AUNT MINNIESCLASSICS教学课件.pptVIP

AUNT MINNIES/CLASSICS An Aunt Minnie case is like your familiar Aunt. You just look at her and you recognize her. That’s who it is. It doesn’t take a lot of analysis if you know her. The following is an Aunt Minnie In the preceding case, the most obvious abnormality is a large cardiac silhouette Although it is often difficult to assess specific cardiac chamber size on CXR, in this case the heart is enlarged inferiorly and laterally to the left suggesting that this heart has left ventricular enlargement, perhaps due to chronic hypertension In this case the patient does have long-standing hypertension, due to an etiology which can be diagnosed on CXR The Aunt Minnie finding here is rib notching, indicating coarctation of the aorta (see following magnification view of ribs) Although coarctation can present even at birth if severe enough, milder cases may even present in adulthood, as in this 67-year-old patient The coarctation typically causes a stenosis of the thoracic aorta just after the origin of the left subclavian artery, resulting in hypertension in the upper body, but not lower (this is like renovascular hypertension, but with the stenosis even farther upstream) The rib notching is caused by collateral flow around the coarctation (subclavians to internal mammaries to anterior intercostals to posterior intercostals to descending aorta) The notching is on the bottom of ribs only since that’s where the vessels travel Rib notching is not usually seen under age 7, because it takes time for the collaterals to enlarge, become tortuous, and eroding the ribs Another classic case on the following 2-view CXR Finding most apparent on the lateral Following is a CT on the preceding thymoma case Note how the tumor projects into each hemithoax, causing the subtle extra edge shadows on the PA CXR The mass contains calcifications, common in thymomas, mediastinal goiter, and teratoma, but uncommon in lymphoma unless previously treated The following is another Aunt Minnie