Imaging

Pulmonary Stenosis

Preliminary Diagnosis: Pulmonary Stenosis

I. What imaging technique is first-line for this diagnosis?

Trans-thoracic 2D echocardiography.

II. Describe the advantages and disadvantages of this technique for diagnosing pulmonary stenosis.

Advantages

  • Offers exquisite anatomical and functional imaging.

  • Does not expose patients to ionizing radiation.

  • Helps detect pressure gradients and velocities across a diseased valve and helps guide treatment.

Disadvantages

  • Operator dependent.

III. What are the contraindications for the first-line imaging technique?

No specific contraindications exist.

IV. What alternative imaging techniques are available?

  • PA and lateral view of the chest.

  • CTA.

  • MR/MRA of the heart.

  • Conventional cardiac catheter angiography.

V. Describe the advantages and disadvantages of the alternative techniques for diagnosing pulmonary stenosis.

PA and lateral view of the chest

Advantages

  • Relatively inexpensive, portable imaging modality.

  • Exposes patients to negligible ionizing radiation.

Disadvantages

  • Moderately sensitive and poorly specific in detecting and diagnosing pulmonary stenosis.

  • Does not allow for adequate delineation of the surrounding anatomical structures.

CTA

Advantages

  • Offers exquisite detail of the anatomical structures, including vascular, soft tissue, lymphatic, and osseous structures.

Disadvantages

  • Exposes patients to ionizing radiation.

  • Does not allow for therapeutic intervention.

  • Useful for evaluating supravalvular and peripheral pulmonary stenosis.

MR/MRA of the heart

Advantages

  • Does not expose patients to ionizing radiation.

  • Useful for evaluating supravalvular and peripheral pulmonary stenosis.

Disadvantages

  • Expensive.

  • Time consuming.

  • Offers less exquisite detail of the surrounding vascular structures.

  • May be subject to motion and susceptibility weighted image artifact.

  • Must be cardiac gated.

Conventional cardiac catheter angiography

Advantages

  • Offers exquisite detail of the cardiac valvular architecture and helps detect any other coexisting abnormalities.

  • Allows for diagnosis and therapeutic intervention simultaneously.

Disadvantages

  • Exposes patients to greater morbidity and mortality secondary to the invasive nature of the exam.

  • Exposes patients to large amounts of ionizing radiation.

VI. What are the contraindications for the alternative imaging techniques?

PA and lateral view of the chest

  • No specific contraindication. Some institutions may have pregnant patients sign consent

CTA

  • May be contraindicated in pregnant patients.

  • Relative contraindication in patients with renal failure and contrast allergy

MR/MRA of the heart

  • Contraindicated in patients with non-MR compatible hardware.

Conventional cardiac catheter angiography

  • Contraindicated in patients who are in a severe hypocoaguable state.

You must be a registered member of ONA to post a comment.

Sign Up for Free e-newsletters

Regimen and Drug Listings

GET FULL LISTINGS OF TREATMENT Regimens and Drug INFORMATION

Bone Cancer Regimens Drugs
Brain Cancer Regimens Drugs
Breast Cancer Regimens Drugs
Endocrine Cancer Regimens Drugs
Gastrointestinal Cancer Regimens Drugs
Genitourinary Cancer Regimens Drugs
Gynecologic Cancer Regimens Drugs
Head and Neck Cancer Regimens Drugs
Hematologic Cancer Regimens Drugs
Lung Cancer Regimens Drugs
Other Cancers Regimens
Rare Cancers Regimens
Skin Cancer Regimens Drugs