case_images: PMC9136032_01
case_images: PMC9136032_02
case_images: (a) Patient in the supine position. (A-E) are the slices of the AAO after the contrast agent injects 9s, 13s, 18s, 23s, and 28s in the Smart Prep Series. (b) Patient in the right lateral decubitus position. (A-E) are the slices of the AAO after the contrast agent injects 9s, 13s, 18s, 23s, and 27s in the Smart Prep Series.
case_images: fcvm-09-893355-g001.jpg
case_images: PMC9136032_02_fcvm-09-893355-g001.jpg
case_images: F1
case_images: The patient was in the supine position at the first scan and changed to the right lateral decubitus position at the second scan (Figures 1a,b).
case_images: (A) Patient in the supine position. The axial view demonstrating an arc-shaped low-attenuation filling defect (white arrow) was seen in the root of the aorta, while the DAO was filling well. The multiplanar reformatted image from the CTA showed no contrast agent filling in the bypass of the right coronary artery (white star). (B) Patient in the right lateral decubitus position. The arc-shaped low-attenuation filling defect disappeared (white arrow), and the bypass of the right coronary artery filled well (white star). (C) The echocardiography (Philips EPIQ 7C; 45  reclining position; Three-chamber view) demonstrated the extremely low velocity of the aortic valve and no thrombus formation in the aortic root (white star).
case_images: fcvm-09-893355-g002.jpg
case_images: PMC9136032_02_fcvm-09-893355-g002.jpg
case_images: F2
case_images: In this case, an ECG-gated multidetector CTA showed a filling defect in the root of the aorta and no visualization of the bypass of the right coronary artery when the patient was in the supine position, while the DAO was filling well (Figure 2A). After turning the position to the right lateral decubitus position, the arc-shaped low-attenuation filling defect disappeared, and the bypass of the right coronary artery was filled with the contrast agent (Figure 2B). Transthoracic conventional echocardiography and two-dimensional spectral Doppler show that the blood flow velocity of the aortic valve was extremely low and there was no thrombus formation in the aortic root (Figure 2C).
case_images: (a) Patient in the supine position. The axial view demonstrated an arc-shaped low-attenuation filling defect ("watershed" phenomenon) in the root of the aorta while the DAO was filling well. The multiplanar reformatted image from the CTA showed no contrast agent filling in the right coronary. (b) Patient in the right lateral decubitus position. The arc-shaped low-attenuation filling defect disappeared and the right coronary filled well. (Left dominant coronary artery; (c) The echocardiography (GE Vivid E95; 45  reclining position; Five-chamber view) demonstrated the extremely low velocity of the aortic valve and there was no thrombus formation in the aortic root (white star).
case_images: fcvm-09-893355-g003.jpg
case_images: PMC9136032_02_fcvm-09-893355-g003.jpg
case_images: F3
case_images: In this case, the ECG-gated multidetector CT angiography showed a filling defect in the root of the aorta with no visualization of the right coronary artery when the patient was in the supine position, while the DAO was filling well (Figure 3a). In addition, changing the patient's scanning position resulted in the good filling of the right coronary artery that was not filled on scanning in the supine position (Figure 3b). Transthoracic conventional echocardiography and two-dimensional spectral Doppler show that the blood flow velocity of the aortic valve was extremely low and there was no thrombus formation in the aortic root (Figure 3c).