Question
A 71-year-old patient presented with chest pain and syncope.X ray shows the following features. What can be the most possible diagnosis?
| A. | Mitral Stenosis |
| B. |
Pulmonary Stenosis |
| C. |
Aortic Stenosis |
| D. |
Double Aortic Arch |
Show Answer
|
Correct Answer � C Explanation |
 |
Ans:C.)Aortic Stenosis.
Image shows:
Frontal chest radiograph in aortic stenosis shows a dilated ascending aorta (white arrow) that abnormally projects farther to the right than the right heart border. This is caused by
post-stenotic dilatation of the aorta.
AORTIC STENOSIS
General Considerations
- Most often as a result of degeneration of the bicuspid aortic valve
- Less commonly rheumatic heart disease or secondary to degeneration
of a tricuspid aortic valve in person > 65
Location
- Supravalvular
- Uncommon
- Associated with William’s Syndrome
- Hypercalcemia
- Elfin facies
- Pulmonary stenoses
- Hypoplasia of aorta
- Stenoses in
- Renal, celiac, superior mesenteric arteries
- Valvular
- Most common
- Either congenital (from a bicuspid aortic valve) or acquired
- The bicuspid aortic valve is the most common congenital cardiac anomaly
- 0.5 –2%
- Subvalvular
- Associated with
- Hypoplastic left heart syndrome
- Idiopathic Hypertrophic Subaortic Stenosis
- Hypertrophic cardiomyopathy
- Subaortic fibrous membrane
Types
- Congenital aortic stenosis (more common)
- Most frequent congenital heart disease associated with
intra-uterine growth retardation (IUGR) - Subvalvular (30%)
- Valvular (70%)
- Degeneration of bicuspid valve
- Supravalvular
- Acquired aortic stenosis
- Rheumatic valvulitis
- Almost invariably associated with mitral valve disease
- Fibrocalcific senile aortic stenosis
- Degenerative
Clinical Findings
- Asymptomatic for many years
- Classical triad
- Angina
- Syncope
- Shortness of breath (heart failure)
- Systolic ejection murmur
- Carotid pulsus parvus et tardus
- Diminished aortic component of 2nd heart sound
- Sudden death in severe stenosis after exercise
- Diminished flow in coronary arteries causes ventricular dysrhythmias
and fibrillation - Decompensation leads to left ventricular dilatation and pulmonary
venous congestion
Imaging Findings
- In older children or young adults
- Prominent ascending aorta
- Post stenotic dilatation of ascending aorta
- Due to turbulent flow
- Left ventricular heart configuration
- Normal-sized or enlarged left ventricle
- Concentric hypertrophy of left ventricle produces a relatively small
left ventricular chamber with thick walls - Heart size is frequently normal
- In adults >30 years
- Prominent ascending aorta
- Post stenotic dilatation of ascending aorta
- Due to turbulent flow
- Calcification of aortic valve (best seen on RAO)
- Normal to an enlarged left ventricle
