6. Cardiac Radiology Normal

8/16/2019 6. Cardiac Radiology Normal

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The Heart Size

C:T RATIO: The simplest way to estimate the heart size.

Measured by relating the widest diameter of the heart to the

widest internal diameter of the chest.


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Postero-Anterior (PA) View

SVC

IVC


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RA


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Right Atrial Enlargement

•Increased convexity

of the lower right

heart border


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• Right Atrium

In some cases, the length

of right heart border exceeds

50% of the mediastinal

cardiovascular shadow


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RV


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Right Ventricle Enlargement

PA View:

•Rounding and

upliftment of cardiac

apex


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PA


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LA


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Left Atrial Enlargement

PA view:

1. Double density,

(r) cardiac border2. Enlargement of

LA appendage


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PA View:

3. Widening of carinal

angle, >60o

4. Upliftment of left

mainstem

bronchus


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LV


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Left Ventricular Enlargement

PA View:

- Round (L) cardiac border

- Lateral, downwarddisplacement of cardiac

apex

-Elongation LV outflowtract


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Aorta


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• Right border

– Superior vena cava

– Right atrium

– Inferior vena cava


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• Right border

– Superior vena cava

– Right atrium

– Inferior vena cava

• Left border

– Aortic knob

– Main pulmonary trunk

– Left ventricle


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• Pulmonary Arteries

– Right


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Pulmonary Arteries

Right

Left


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– Right

– Left

• Pulmonary VeinsLA


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Lateral View

RA

SVC

IVC


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Lateral View

RV


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Right Ventricle

Lateral View• Retrosternal

fullness• R heart

border greater than

1/3 of the retro

sternal length


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Lateral View


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Lateral View

LA


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Lateral view:

- LA fills the upper partof the retro cardiacfree space.

- Barium filledesophagus displaced

posteriorly


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Lateral View

LV


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Lateral View

Aorta


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Lateral View

– Left Ventricle

– Hoffman Rigler Sign


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Left Ventricle Enlargement

Lateral View

• Posterior displacement

posterior border

of the heart

*Hoffman-Rigler Sign:

measured 2 cm above the intersection

of the diaphragm and IVC.(+) posterior border of the LV extends

more than 1.8 cm of IVC


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Lateral View

– Left atrium

– Left ventricle


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Lateral View

– Left atrium

– Left ventricle

– Right ventricle


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Lateral View

• Aorta

• Main Pulmonary Artery

• Inferior vena cava


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Lateral View


– Left

– Right

• Pulmonary Veins


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Teleradiography, 4

1. PA

2. Upright

3. Deep inspiration

4. Tube-filmdistance

of 6 feet


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Areas to be inspected

• Lungs

• Mediastinum –

including the heart and

the great vessels• Trachea and central

bronchi

• DiaphragmD

H

S

A

T


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Areas to be inspected

• Bony thorax

• Soft tissues of the

thorax and neck

• Sub diaphragmatic upperabdominal structures

S

S

AR

C

CP

V

PR

PIS

CP


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S

H

D

A

V

R

RS

RS

T

Areas to be inspected / LAT


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Lung Zones

• Inner zone / inner third -large main trunk vessels

• Middle zone - intermediate

sized vessels

• Peripheral - vessels less than

1 mm in diameter

Pulmonary Vascular Pattern

Normal


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NORMAL


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NORMAL


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NORMAL


INCREASED


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NORMAL


INCREASED


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NORMAL


DECREASED


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NORMAL


DECREASED


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NORMAL


VENOUS

CONGESTION


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VENOUS

CONGESTION

INCREASED

ARTERIAL

BLOOD FLOW


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VENOUS

CONGESTION

Interstitial Edema

Kerley B Lines


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VENOUS

CONGESTION

Interstitial Edema

Kerley B LinesKerley A Lines


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MITRAL STENOSIS


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MITRAL STENOSIS

• Normal to slightlyenlarged heart

• > LA >Lung >RV

• Pulmonary venousHPN

– Equalization

– Reversal/Cephalization


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Mitral Stenosis

• PA: Prominent MPAS and branches; constriction of

arteries in mid and peripheral lung zones

• Small aorta


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Severe MS

• Pulmonary arterial

hypertension, RV

• Pulmonary

hemosiderosis,

ossified densities, LL

• Calcification, LA wall,

laminated clot,

thrombus


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Kerley B in MS

Short, horizontal dense

lines, interstitial edemaand dilatation of the

lymphatics, lower lung

fields


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MITRAL REGURGITATION


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MITRAL REGURGITATION

• Cardiomegaly/Big Heart• Chamber Prominence:

– LA (MR>MS)

– LV

• Pulmonary venous HPN

(MR


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AORTIC STENOSIS


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AORTIC STENOSIS

• Normal-sized heart,

mild cardiomegaly

• LV• +/- Pulmonary venous

hypertension


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AORTIC STENOSIS

• Dilated

ascending aorta

• +/- Aortic valve

calcification


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AORTIC REGURGITATION


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• Cardiomegaly

• LV

• Dilated ascendingaorta and aortic arch

(LV outflow tract)

• Normal pulmonary

vascularity


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• LV enlargement

• Apex extends below the

dome of the (L) hemi

diaphragm• Aorta – ascending, dilated

• Aortic knob – often

prominent

• ‘Cor bovinum’


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Combined Aortic Valve Disease

• Difficult to ascertain

the prominent valve

lesion

• In cardiac failure, signsof pulmonary

congestion develop

with relative MI, LA

enlargement


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TRICUSPID VALVE DISEASE


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TRICUSPID VALVE DISEASE

• RA enlargement; Elongated (R) cardiac border; +/-

SVC or IVC prominence


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Congestive Heart FailureFour Reliable Signs

l Kerley B lines

l Pleural effusions

l Fluid in the fissures

l Peribronchial cuffing


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Kerley B Lines

Four Reliable Signs of CHF

Short (1 -2 cm)

white lines at the

lung bases,

perpendicular to

the pleural surface

representing

distendedinterlobular septa


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Pleural Effusions



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Fluid in the fissures


Fluid in the minor

fissure. The fissures

may be seen normally

but they should be

about as thin as a line

drawn with a

sharpened pencil.


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Peribronchial cuffing


Fluid in the walls of

the bronchi make

them visible and

produce numerous

“doughnut” densities

throughout theperiphery of the lung.


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63 yr old man with chest pain


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•Widened mediastinum

•Left pleural effusion

• Chest pain

Should make you think

of an aortic dissection



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Linear lucency

in the contrast-

filleddescending

aorta is the

intimal flap of an

aortic dissection


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Classification of Dissecting Aneurysms

Stanford classification

•Widened mediastinum• Left pleural effusion

• Chest pain

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6. Cardiac Radiology Normal