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Mitral Stenosis
characterized by fusion of
edges of anterior +
posterior leaflets along
commissure
• Ethiology:
• rheumatic heart disease
• Carcinoid syndrome;
• Eosinophilic endocarditis;
• Rheumatoid arthritis;
• SLE;
• Mass obstructing LV
inflow (tumor, atrial
myxoma, thrombus);
• Congenital (parachute
MV, double-orifice MV)
• Stages (according to degree of pulmonary
venous hypertension):
• Stage 1 : loss of hilar angle, redistribution
• Stage 2 : interstitial edema
• Stage 3 : alveolar edema
• Stage 4 : hemosiderin deposits + ossification
Radiographic Cardiac and Pulmonary
Parenchymal Manifestation
Left Heart;
• Enlarged Left Atrium
• Double Density Sign
• Splaying of mainstem Bronchi
• Displacement of esophagus
Right heart
• •prominent pulmonary artery segment
• •dilatation of RV
• •increase in cardiothoracic ratio
• •diminution of retrosternal clear space
• •IVC pushed backward (lateral view)
Pulmonary
• Pulmonary Vascular Cephalization, Interstitial Edema, Alveolar
edema, Pulmonary Edema
• Diffuse Alveolar Hemorrage ( Window frame Effect)
• Pulmonary Hemosiderosis
• Pulmonary Ossification
MS
Kerley B Lines
Displacement of esophagus
posteriorly
Pulmonary Calcification
Displacement of left Bronchus
Pulmonary Hemosiderosis
Calcification of Mitral Annulus
and Mural Thrombi
Lutembacher Syndrome
Echocardiography: Parasternal
Normal Mitral Stenosis
Source Undetermined Source Undetermined
Echocardiography: Short Axis
Normal Mitral Stenosis
Source Undetermined Source Undetermined
• CT in a 61-year-old man shows the straight
anterior (black arrow) and curved posterior (black
arrowhead) portions of the normal mitral annulus
Philipp Blanke et al. JIMG 2015;8:612-615
2015 American College of Cardiology Foundation
The D-shaped cross-sectional configuration can be appreciated on the
short-axis projection (A), whereas preservation of the LVOT is
discernible on the 3-chamber view (B) and vertical long-axis projection
(C)
• Mitral stenosis. Axial CT angiogram (a) and coronal multiplanar
reformatted image (b) show a dilated left atrium ( ) and a funnel-
shaped mitral valve (arrow) with irregularly thickened leafl ets.
Arrowheads in b indicate calcifi cation of the annulus and of a
leafl et of the mitral valve.
Rheumatic Mitral Stenosis
ECG-gated dual-source 64- channel CT in a 62-year-old woman with
rheumatic mitral stenosis shows thickening of the mitral valve leaflets
(arrows) with commissural fusion and calcification (arrowhead), features
that produce a characteristic “fish-mouth” appearance.
Rheumatic Mitral Stenosis
• MR imaging in a 74-year-old woman with rheumatic mitral stenosis
shows anterior leaflet thickening and bowing (arrow), which produces
a “hockey-stick” appearance. The posterior leaflet is also thickened
(arrowhead).
Thank You
“The eyes see only what the mind knows”

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Mitral stenosis

  • 1. Mitral Stenosis characterized by fusion of edges of anterior + posterior leaflets along commissure
  • 2.
  • 3.
  • 4. • Ethiology: • rheumatic heart disease • Carcinoid syndrome; • Eosinophilic endocarditis; • Rheumatoid arthritis; • SLE; • Mass obstructing LV inflow (tumor, atrial myxoma, thrombus); • Congenital (parachute MV, double-orifice MV)
  • 5. • Stages (according to degree of pulmonary venous hypertension): • Stage 1 : loss of hilar angle, redistribution • Stage 2 : interstitial edema • Stage 3 : alveolar edema • Stage 4 : hemosiderin deposits + ossification
  • 6. Radiographic Cardiac and Pulmonary Parenchymal Manifestation Left Heart; • Enlarged Left Atrium • Double Density Sign • Splaying of mainstem Bronchi • Displacement of esophagus Right heart • •prominent pulmonary artery segment • •dilatation of RV • •increase in cardiothoracic ratio • •diminution of retrosternal clear space • •IVC pushed backward (lateral view) Pulmonary • Pulmonary Vascular Cephalization, Interstitial Edema, Alveolar edema, Pulmonary Edema • Diffuse Alveolar Hemorrage ( Window frame Effect) • Pulmonary Hemosiderosis • Pulmonary Ossification
  • 7. MS
  • 9.
  • 14. Calcification of Mitral Annulus and Mural Thrombi
  • 16.
  • 17. Echocardiography: Parasternal Normal Mitral Stenosis Source Undetermined Source Undetermined
  • 18. Echocardiography: Short Axis Normal Mitral Stenosis Source Undetermined Source Undetermined
  • 19.
  • 20. • CT in a 61-year-old man shows the straight anterior (black arrow) and curved posterior (black arrowhead) portions of the normal mitral annulus
  • 21. Philipp Blanke et al. JIMG 2015;8:612-615 2015 American College of Cardiology Foundation The D-shaped cross-sectional configuration can be appreciated on the short-axis projection (A), whereas preservation of the LVOT is discernible on the 3-chamber view (B) and vertical long-axis projection (C)
  • 22. • Mitral stenosis. Axial CT angiogram (a) and coronal multiplanar reformatted image (b) show a dilated left atrium ( ) and a funnel- shaped mitral valve (arrow) with irregularly thickened leafl ets. Arrowheads in b indicate calcifi cation of the annulus and of a leafl et of the mitral valve.
  • 23. Rheumatic Mitral Stenosis ECG-gated dual-source 64- channel CT in a 62-year-old woman with rheumatic mitral stenosis shows thickening of the mitral valve leaflets (arrows) with commissural fusion and calcification (arrowhead), features that produce a characteristic “fish-mouth” appearance.
  • 24. Rheumatic Mitral Stenosis • MR imaging in a 74-year-old woman with rheumatic mitral stenosis shows anterior leaflet thickening and bowing (arrow), which produces a “hockey-stick” appearance. The posterior leaflet is also thickened (arrowhead).
  • 25. Thank You “The eyes see only what the mind knows”