Don’t try to track tortuous coronaries on axial slices. Instead, use the axial views to systematically review cardiac and non-cardiac structures at four distinct levels.
Assess the aorta and pulmonary artery. Normal:
- Ascending aorta < 40 mm
- PA < 28 mm
Assess the aortic valve. Remember the “lucky 40” metric: 40 mm is the upper limit of normal for the aortic root, the left atrium, and the right ventricular outflow tract.
Evaluate the LV chamber size (normal < 55 mm) and wall thickness (normal < 11 mm). This level is also where you spot myocardial ischemia or infarction — dark, hypodense subendocardial regions that fail to pick up contrast.
Determine coronary dominance by seeing which artery gives rise to the PDA. Also evaluate extracardiac structures — the liver (congestion, cysts) and the esophagus (hiatal hernias).