Bio

Professional Education


  • Board Certification: American Board of Radiology, Diagnostic Radiology (2011)
  • Residency: University of Texas Health Sciences Center at San Antonio Radiology Residency (2010) TX
  • Internship: University of Texas Health Science Center San Antonio Internal Medicine Residency (2005) TX
  • PhD Training: Mayo Clinic Rochester (2004) MN
  • Medical Education: Mayo Clinic School of Medicine (2004) MN

Publications

All Publications


  • Aortic Dissection and Other Acute Aortic Syndromes: Diagnostic Imaging Findings from Acute to Chronic Longitudinal Progression. Radiographics : a review publication of the Radiological Society of North America, Inc Murillo, H., Molvin, L., Chin, A. S., Fleischmann, D. 2021; 41 (2): 425–46

    Abstract

    Acute aortic dissection is the prototype of acute aortic syndromes (AASs), which include intramural hematoma, limited intimal tear, penetrating atherosclerotic ulcer, traumatic or iatrogenic aortic dissection, and leaking or ruptured aortic aneurysm. The manifestation is usually sudden and catastrophic with acutely severe tearing chest or back pain. However, clinical symptoms do not allow distinction between AAS types and other acute pathologic conditions. Diagnostic imaging is essential to rapidly confirm and accurately diagnose the type, magnitude, and complications of AASs. CT fast acquisition of volumetric datasets has become instrumental in diagnosis, surveillance, and intervention planning. Most critical findings affecting initial intervention and prognosis are obtained at CT, including involvement of the ascending aorta, primary intimal tear location, rupture, malperfusion, size and patency of the false lumen, complexity and extent of the dissection, maximum caliber of the aorta, and progression or postintervention complications. Involvement of the ascending aorta-Stanford type A-has the most rapid lethal complications and requires surgical intervention to affect its morbidity and mortality. Lesions not involving the ascending aorta-Stanford type B-have a lesser rate of complications in the acute phase. During the acute to longitudinal progression, various specific and nonspecific imaging findings are encountered, including pleural and pericardial effusions, fluid collections, progression including aortic enlargement, and postoperative changes that can be discerned at CT. A systematic analysis algorithm is proposed for CT of the entire aorta throughout the continuum of AASs into the chronic and posttreated disease state, which synthesizes and communicates salient findings to all care providers. Online supplemental material is available for this article. ©RSNA, 2021.

    View details for DOI 10.1148/rg.2021200138

    View details for PubMedID 33646901

  • Infectious Diseases of the Heart: Pathophysiology, Clinical and Imaging Overview. Radiographics : a review publication of the Radiological Society of North America, Inc Murillo, H. n., Restrepo, C. S., Marmol-Velez, J. A., Vargas, D. n., Ocazionez, D. n., Martinez-Jimenez, S. n., Reddick, R. L., Baxi, A. J. ; 36 (4): 963–83

    Abstract

    Myriad infectious organisms can infect the endocardium, myocardium, and pericardium, including bacteria, fungi, parasites, and viruses. Significant cardiac infections are rare in the general population but are associated with high morbidity and mortality as well as increased risk in certain populations, such as the elderly, those undergoing cardiac instrumentation, and intravenous drug abusers. Diagnostic imaging of cardiac infections plays an important role despite its variable sensitivity and specificity, which are due in part to the nonspecific manifestations of the central inflammatory process of infection and the time of onset with respect to the time of imaging. The primary imaging modality remains echocardiography. However, cardiac computed tomography and magnetic resonance (MR) imaging have emerged as the modalities of choice wherever available, especially for diagnosis of complex infectious complications including abscesses, infected prosthetic material, central lines and instruments, and the cryptic manifestations of viral and parasitic diseases. MR imaging can provide functional, morphologic, and prognostic value in a single examination by allowing characterization of inflammatory changes from the acute to chronic stages, including edema and the patterns and extent of delayed gadolinium enhancement. We review the heterogeneous and diverse group of cardiac infections based on their site of primary cardiac involvement with emphasis on their cross-sectional imaging manifestations. Online supplemental material is available for this article. (©)RSNA, 2016.

    View details for DOI 10.1148/rg.2016150225

    View details for PubMedID 27399236

  • Hypertrophic Cardiomyopathy from A to Z: Genetics, Pathophysiology, Imaging, and Management. Radiographics : a review publication of the Radiological Society of North America, Inc Baxi, A. J., Restrepo, C. S., Vargas, D. n., Marmol-Velez, A. n., Ocazionez, D. n., Murillo, H. n. ; 36 (2): 335–54

    Abstract

    Hypertrophic cardiomyopathy (HCM) is a heterogeneous group of diseases related to sarcomere gene mutations exhibiting heterogeneous phenotypes with an autosomal dominant mendelian pattern of inheritance. The disorder is characterized by diverse phenotypic expressions and variable natural progression, which may range from dyspnea and/or syncope to sudden cardiac death. It is found across all racial groups and is associated with left ventricular hypertrophy in the absence of another systemic or cardiac disease. The management of HCM is based on a thorough understanding of the underlying morphology, pathophysiology, and clinical course. Imaging findings of HCM mirror the variable expressivity and penetrance heterogeneity, with the added advantage of diagnosis even in cases where a specific mutation may not yet be found. The diagnostic information obtained from imaging varies depending on the specific stage of HCM-phenotype manifestation, including the prehypertrophic, hypertrophic, and later stages of adverse remodeling into the burned-out phase of overt heart failure. However, subtle or obvious, these imaging findings become critical components in diagnosis, management, and follow-up of HCM patients. Although diagnosis of HCM traditionally relies on clinical assessment and transthoracic echocardiography, recent studies have demonstrated increased utility of multidetector computed tomography (CT) and particularly cardiac magnetic resonance (MR) imaging in diagnosis, phenotype differentiation, therapeutic planning, and prognostication. In this article, we provide an overview of the genetics, pathophysiology, and clinical manifestations of HCM, with the spectrum of imaging findings at MR imaging and CT and their contribution in diagnosis, risk stratification, and therapy.

    View details for DOI 10.1148/rg.2016150137

    View details for PubMedID 26963450

  • Imaging of Intrathoracic Paragangliomas. Seminars in ultrasound, CT, and MR Ocazionez, D. n., Shroff, G. S., Vargas, D. n., Dicks, D. n., Chaturvedi, A. n., Nachiappan, A. C., Murillo, H. n., Baxi, A. n., Restrepo, C. S. 2017; 38 (6): 584–93

    Abstract

    Intrathoracic paragangliomas are uncommon and only represent 1%-2% of paragangliomas. They are most commonly found in mediastinal compartments (aortopulmonary window or posterior mediastinum). Computed tomography, magnetic resonance, and specific nuclear medicine radiotracers are routinely used to characterize these lesions and help exclude other more common conditions. Selective angiography is currently used for preoperative embolization and mapping of the vascular supply before surgical resection, rather than for diagnostic purposes alone.

    View details for DOI 10.1053/j.sult.2017.07.004

    View details for PubMedID 29179898

  • Spectrum of Critical Imaging Findings in Complex Facial Skeletal Trauma RADIOGRAPHICS Winegar, B. A., Murillo, H., Tantiwongkosi, B. 2013; 33 (1): 3-19

    Abstract

    Multidetector computed tomography (CT) is the modality of choice for the evaluation of facial trauma because it helps accurately identify and characterize fractures and associated complications, thereby aiding timely clinical management and surgical planning. In particular, CT clearly depicts clinically relevant fractures in the eight osseous struts or buttresses that function as an underlying scaffold for facial structures. Information about the involvement of specific facial buttresses in a complex fracture is helpful for determining the type of fracture present and for identifying associated soft-tissue injuries that may require urgent care or surgery. Various kinds of complications can be expected to occur in Le Fort fractures, which affect the full thickness of the pterygoid plates, with resultant dissociation of part or all of the maxilla from the skull base; naso-orbitoethmoid complex fractures, which involve the medial orbital wall, nasal bone, ethmoid sinuses, and, often, the attachment site of the medial canthal tendon; zygomaticomaxillary complex fractures, which disrupt all four zygomatic sutures and may lead to enophthalmos due to increased orbital volume because of angulation of the lateral orbital wall; orbital "blowout" fractures, which may result in extraocular muscle herniation or entrapment and injuries to the globe or the infraorbital nerve; and fractures of the alveolar process, which are treated as open fractures because of their extension through the gingiva to the oral cavity and their resultant vulnerability to infection. Similarly, extension of a frontal sinus fracture through the posterior sinus wall creates a portal to the anterior cranial fossa and may lead to cerebrospinal fluid leakage, intracranial hemorrhage, or intracranial infection.

    View details for DOI 10.1148/rg.331125080

    View details for Web of Science ID 000313748500004

    View details for PubMedID 23322824

  • Pulmonary Circulation Imaging: Embryology and Normal Anatomy SEMINARS IN ULTRASOUND CT AND MRI Murillo, H., Cutalo, M. J., Jones, R. P., Lane, M. J., Fleischmann, D., Restrepo, C. S. 2012; 33 (6): 473-484

    Abstract

    This review focuses on the embryology and normal imaging anatomy of the pulmonary circulation, with emphasis on the major arterial and venous vasculature. The pulmonary circulation and parenchyma have a complex intertwined embryologic origin. Understanding the embryologic basis of normal pulmonary vasculature aids recognition of anomalies and visceral situs in the chest. Adaptive changes to congenital anomalies of the pulmonary arterial vasculature are used to contrast from normal and review associated temporal adaptive vascular and parenchymal changes.

    View details for DOI 10.1053/j.sult.2012.08.001

    View details for Web of Science ID 000312179300002

    View details for PubMedID 23168059

  • Anomalous Pulmonary Venous Connections SEMINARS IN ULTRASOUND CT AND MRI Katre, R., Burns, S. K., Murillo, H., Lane, M. J., Restrepo, C. S. 2012; 33 (6): 485-499

    Abstract

    Developmental lung anomalies are classified into 3 main categories: bronchopulmonary (lung bud) anomalies, vascular anomalies, and combined lung and vascular anomalies. These anomalies are uncommon, and patients are at times asymptomatic; hence, identifying a developmental lung anomaly in the adult can be a challenge. Pulmonary vascular anomalies include interruption or absence of the main pulmonary artery, anomalous origin of the left pulmonary artery from the right pulmonary artery, anomalous pulmonary venous drainage (partial or complete), and pulmonary arteriovenous malformations. Systemic vascular anomalies comprise persistent left superior vena cava, anomalies of azygos and hemiazygos systems, and anomalies of the thoracic aorta and its major branches. In this article, we present embryology, classification, epidemiology, clinical presentation, and imaging features of anomalous pulmonary venous connections, with special emphasis on multidetector computed tomography and magnetic resonance imaging. These state-of-art imaging techniques have facilitated accurate and prompt diagnosis of these anomalies.

    View details for DOI 10.1053/j.sult.2012.07.001

    View details for Web of Science ID 000312179300003

    View details for PubMedID 23168060

  • Cardiac Aneurysms, Pseudoaneurysms, and Diverticula SEMINARS IN ROENTGENOLOGY Restrepo, C. S., Lane, M. J., Murillo, H. 2012; 47 (3): 262-276

    View details for DOI 10.1053/j.ro.2011.11.011

    View details for Web of Science ID 000305048900009

    View details for PubMedID 22657116

  • Imaging of the Aorta: Embryology and Anatomy SEMINARS IN ULTRASOUND CT AND MRI Murillo, H., Lane, M. J., Punn, R., Fleischmann, D., Restrepo, C. S. 2012; 33 (3): 169-190

    Abstract

    This review focuses on the embryology and anatomy of the aorta with some imaging examples. Dividing the aorta by segments of unique function and embryogenesis facilitates organizing the group of potential anomalies encountered. A basic understanding of the embryologic development of the aorta and its major branches helps in understanding and recognizing typical and atypical anatomic findings. Diagnostic imaging of the aorta and its major branches can be accomplished by invasive and noninvasive methods, based on the clinical scenario and the age of the patient. In this review, computed tomography and magnetic resonance imaging examples are emphasized.

    View details for DOI 10.1053/j.sult.2012.01.013

    View details for Web of Science ID 000305094700002

    View details for PubMedID 22624964

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