Congenital Heart Disease: a Pictorial Illustration of Putting Segmental Approach into Practice

The human heart is a complex organ in which many complicated congenital defects may happen and some of them require surgical intervention. Due to the vast complexity of varied anatomical presentations, establishing an accurate and consistent nomenclature system is utmost important to facilitate effective communication among pediatric cardiologists, cardiothoracic surgeons and radiologists. The Van Praagh segmental approach to the complex congenital heart disease (CHD) was developed in the 1960s and has been used widely as the language for describing complex anatomy of CHD over the decades. It utilizes a systematic and sequential method to describe the cardiac segments and connections which in turn allows accurate, comprehensive and unambiguous description of CHD. It can also be applied to multiple imaging modalities such as echocardiogram, cardiac CT and MRI. The Van Praagh notation demonstrates a group of three letters, with each letter representative for a key embryologic region of cardiac anatomy: the atria, ventricles and great vessels. By using a 3-steps approach, we can evaluate complex CHD precisely and have no difficulties in communicating with other medial colleague. This pictorial essay revisits the logical steps of segmental approach, followed by a pictorial illustration of its application.

Adenosquamous carcinoma presenting as liver abscess

Adenosquamous carcinoma (ASC) has a nonspecific presentation. We report a patient with ASC who presented with fever and epigastric pain. Computed tomographic findings and clinical features were suggestive of a liver abscess, while ultrasonography showed a complex space-occupying lesion. Biopsy revealed a lesion with malignant glandular and squamous components, a finding that was compatible with ASC. Complex space-occupying lesions should raise the suspicion of a mass lesion. Subtle imaging clues of a metastatic disease were reviewed retrospectively.