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1. CARDIOVASCULAR X-RAY
Kr Shashikant Raj
Group 13
6th Year 11th Semester
Moderator:-
Dr Murat Tkhilaev M
Department of General Medicine
Asian Medical Institute

2. Introduction
In this chapter we are going to studies about heart X-ray.
To check normal cardiac X-ray we refer to CARDIAC SILHOUETTE, which the
outline of the heart as seen on frontal and lateral chest radiographs and
forms part of the cardiomediastinal contour.
The size, shape and position of the cardiac silhouette provide useful clues for
underlying disease.

3. Cardiomediastinal Contour

4. Projection
● Posteroanterior (PA) view
● Anteroposterior (AP) erect view (for coronary vessels)
● Lateral view

7. Basic X-ray Features
● Heart Dislocation
● Heart Enlargement
● Pericardial Anomalies
● Abnormal Pulmonary blood flow

9. Cardiomegaly is easily visualized on chest x ray.

11. Aetiology
There are many aetiologies for cardiomegaly:
Congestive heart failure
Ischaemic heart disease
Hypertension (with left ventricular hypertrophy)
Valvular disease (mitral regurgitation, tricuspid regurgitation, aortic stenosis, aortic regurgitation,
subacute bacterial endocarditis)
Cardiomyopathy (idiopathic cardiomyopathy, alcoholic cardiomyopathy, hypertrophic
cardiomyopathy, drugs)
Congenital heart disorders (ASD, VSD, PDA, coarctation of the aorta, Ebstein anomaly, tetralogy of
Fallot)
Pulmonary disease (leading to right-sided enlargement)
Myocarditis
Systemic disease/physiology

13. Right Artial Enlargement
Right atrial (RA) enlargement is less common,
and harder to visualies on chest radiograph,
than left atrial (LA) enlargement.
Enlargement of the right atrium (RA) can result
from a number of conditions, including:
● Increase right ventricular pressures
● Valvular disease
● Atrial septal defect (ASD)
● Atrial fibrillation (AF)
● Dilated cardiomyopathy

15. Left Venticular Enlargement
Left ventricular enlargement can be the result
of a number of conditions, including:
● Pressure Overload
● Volume Overload
● Wall Abnormalities

16. The Hoffman-Rigler sign is a sign of
left ventricular enlargement
inferred from the distance between
the inferior vena cava (IVC) and left
ventricle (LV).​
Hoffman-Rigler sign

17. Rigler’s Measurement
Rigler’s A & B used to differentiate left ventricular and right ventricular
enlargement.

18. Shmoo sign refers to the appearance
of a prominent, rounded left ventricle
and dilated aorta on a plain PA chest
radiograph giving the appearance of
Shmoo
Shmoo Sign

23. Pericardial cysts
Pericardial cysts are uncommon benign congenital anomalies of the anterior and middle
mediastinum.

24. Aortic Knob
The aortic knob or knuckle refers to the frontal chest x-ray appearance of
the distal aortic arch as it curves posterolaterally to continue as the
descending thoracic aorta. It appears as a laterally-projecting bulge, as the
medial aspect of the aorta cannot be seen separate from the mediastinum.
It forms the superior border of the left cardiomediastinal contour.
Aortic knob diameter increased with age (p – 0.000). The mean
aortic knob diameter of males was higher than for females
(3.14± 0.34cm versus 2.77± 0.37cm, p – 0.000).

25. Aortic aneurysm is a focal or diffuse dilatation of the aorta involving all three layers of
the aortic wall. Most of the aneurysms are caused by atherosclerosis, trauma,
infection and genetic syndromes are other causes.
Aortic Aneurysm

26. Saccular Aortic Aneurysm
Hilum Overlay Sign
Saccular aneurysm is a focal dilation of the vessel wall that is attached to a
stalk

27. MPA Measurement
Computed tomography (CT) is widely used for
evaluation of various artery around the heart.

28. Pulmonary edema usually confirmed on X-ray, which shows increased fluid in the alveolar walls.
Pulmonary edema
Findings on an x-ray suggestive of pulmonary edema include:
● Cephalization (redistribution of blood into the upper lobe vessels)
● Increased cardio-thoracic ratio
● Peribronchial Cuffing (peribronchial thickening or bronchial wall thickening)
● Bat wing opacities