Wednesday, September 2, 2009

To Lift Up

A 60 year old gentleman presents to your clinic complaining of angina, dizziness, and dyspnea on exertion. He notes decreased exercise tolerance compared to several years ago. On physical exam, you note a slow rate of rise in the carotid pulse, a mid to late peaking systolic murmur at the right second intercostal space, and reduced intensity of the second heart sound. The cardiac impulse is sustained.

Ah, yes, the ever important arrow and circle sign. This might help orient you: the blue line on the lateral view is drawn from the carina to the junction of the diaphragm with the anterior chest wall.

Challenge: The Greek word for "to lift up" would tell you the anatomical location of the pathology. What's going on?

Image shown under fair use.


Stephanie said...

mitral regurge?

Craig Chen said...

ah, close
To Lift Up

According to Wikipedia, aorta comes from the Greek word "to lift up." This is aortic stenosis. In the CXR, the white arrow indicates enlargement of the ascending aorta, the red arrow indicates left ventricular enlargement, and the circle shows calcifications in the region of the aortic valve leaflets. In relation to the blue line, the aortic valve lies above it while the mitral valve lies below it.

Sources: UpToDate; LearningRadiology.