How to tell LAD vs LCX apart on CT?

[student456]

I got a question wrong on UWqbank about LAD vs LCX so I was looking through more pics on google. After going through them, I was thinking if the question asks about LAD I should always go for the upper right artery on CT since I have seen it on most of the CT on upper right, but then on some google pics it's the one on the bottom. How can we tell them apart for sure?

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[soon2BdocC]

So, the LAD is a direct continuation from the left main. The circ is going to branch off and serve the anterior lateral portion. That is how I discern which is which. It can be tricky, but the LAD is a straight shot usually unless it's blocked.

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[ATypicalLymphocyte]

This website might be of help:
http://www.cathlabdigest.com/articl...Simple-Easy-Guide-Understanding-Oblique-Views

 

[student456]

Thank you guys...

 

[Instatewaiter]

I got a question wrong on UWqbank about LAD vs LCX so I was looking through more pics on google. After going through them, I was thinking if the question asks about LAD I should always go for the upper right artery on CT since I have seen it on most of the CT on upper right, but then on some google pics it's the one on the bottom. How can we tell them apart for sure?

You're not going to be asked to differentiate them by CT on any board exam exept perhaps the cardiology boards...

The LAD goes to the anterior wall of the LAD. The LCx goes to the lateral wall. That is how you tell.

The Top and bottom left pictures aren't even CTs. They are cardiac caths. They are not going to be in the same configuration as a CT.

The one on the bottom right is showing a coronary anomoly where part of the left coronary artery comes from the right coronary cusp. It appears to be a LCx coming from the right but this could be the left main coming from the RCC. It is obscured by the fact the artery takes an interarterial course so you can't tell from this picture alone. Regardless, this is a bad example.

Let me reiterate though. YOU are never going to be asked this. Don't waste your time.

 

[seminoma]

You're not going to be asked to differentiate them by CT on any board exam exept perhaps the cardiology boards...

The LAD goes to the anterior wall of the LAD. The LCx goes to the lateral wall. That is how you tell.

The Top and bottom left pictures aren't even CTs. They are cardiac caths. They are not going to be in the same configuration as a CT.

The one on the bottom right is showing a coronary anomoly where part of the left coronary artery comes from the right coronary cusp. It appears to be a LCx coming from the right but this could be the left main coming from the RCC. It is obscured by the fact the artery takes an interarterial course so you can't tell from this picture alone. Regardless, this is a bad example.

Let me reiterate though. YOU are never going to be asked this. Don't waste your time.

UW Step 1 has an angio LAO cranial view that requires you to identify the circ. If I remember correctly the vignette was a guy with STE in I and aVL and wanted you to pick the most likely site of occlusion. Figure shown was LAO cranial with vessels labeled A-E. Answer choices were A-E. Don't know if it has shown up on step 1, but the UW writers got the idea from somewhere. I remember this question because I got it wrong (and thought it was a ridiculous question), but something like 80% of people got it right.. which made me feel dumb.

Also I was frequently pimped (as an MS3) by fellows/attendings on identifying vessels on angio.

Just a different opinion/experience.

 

[student456]

Thanks for letting me know.

My question was regarding, UW ID : 11543, 49% got it right.