• Carole Ann Ridge, Diana Litmanovich, Francesco Molinari, Alexander A Bankier, and Ronald L Eisenberg.
• Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA. ridgec@mskcc.org
• J Thorac Imaging. 2013 Mar 1; 28 (2): 129-33.

PurposeTo determine the best radiographic landmark for the cavoatrial junction (CAJ) using electrocardiographic-gated, 64-row multidetector coronary computed tomographic angiography (CTA).Materials And MethodsInstitutional Review Board approval was obtained. Patient age, sex, weight, and height were recorded. The CAJ was localized by 2 readers using multiplanar CTA, cross-referenced with a scout topogram. Designated radiographic landmarks (the carina, intersection between the bronchus intermedius and the right heart border, and the inflection of the right heart border) were assessed for visibility and vertical distance from the CAJ.ResultsSixty consecutive CTA studies (39 men, 21 women; age range, 27 to 98 y; mean±SD, 55±15 y) were analyzed. The closest radiographic landmark to the CAJ was the intersection between the bronchus intermedius and the right heart border (0.9±0.8 cm above the CAJ), visible in 71% of patients. The second closest radiographic landmark was the inflection of the right heart border (1±0.8 cm above the CAJ), visible in 84% of patients. The carina was visible on 100% of topograms, 4.2±1.1 cm above the CAJ. There was no strong correlation between age, weight, height, or sex and the visibility or distance of landmarks from the CAJ.ConclusionsThe intersection of the bronchus intermedius with the right heart border and the inflection of the right heart border are the closest radiographic landmarks to the CAJ. When these landmarks are not identifiable, the most uniformly visible radiographic landmark is the carina.

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