The lecture has been given on Feb. 8th, 2011 by Dr. Abeer.

1. RADIOLOGY Cardiovascular System

2. Imaging Techniques : 1- Plain Radiography : * The standard plain films for evaluation of cardiac diseases are the PA view & Lateral chest film, the PA view must be sufficiently penetrated to see the shadow within the heart, eg. The double contour of the Lt. atrium & valve & pericardial calcification. * It provides limited informationsabout the Heart. * It provides limited informationsabout the effect of the cardiac diseases on the lungs & pleural cavities.

3. * We should assess the following points : a- Heart (shape & size). b- Great vessels (size, shape), Aortic arch (normally located to the Lt. of the Trachea, we should exclude the signs of coarctation of aorta). c- If there is any calcification. d- The main point is the examination of the Lung field for altered blood flow & if there is any evidence of heart failure. ** Note : Look for any thoracic abnormality (such as Pectus Excavatum).

4. Normal CXR in PA view

5. Normal CXR in Lateral view

6. 2- Echocardiography (Cardiac US) : * It is the major or basic imaging technique used in cardiology. * It gives important informations about the Morphology & Function of the heart. * It is an excellent technique to look for : a- Heart valves. b- Chamber morphology & volume. c- Determining the ventricular wall thickness. d- Any intra-luminal mass.

7. 3 basic techniques are used in Echocardiography, & they are : a) M-mode : * It is a continuous scan over a period of time (5-10 seconds), with pencil – beam of sound directed to thesite of interest. * It can demonstrate chamber dimensions, wall thickness, & valve movement (mainly for Lt. ventriculardimension in systole & diastole).

8. M-mode

9. b) Two-dimensional sector scanning (Real time echo.) : * Demonstrates fun-shaped slices of the heart in motion. * Standard examination consists of combination of short & long axis views + 4 chamber view. * Long & short – axis views : cross-section of the of the Lt. ventricle + mitral valve + aortic valve, & it isdone by placing the transducer in the intercostal space, just to the Lt. of the sternum. * 4 chamber view : both ventricles, both atria, mitral & tricuspid valves, & it is done by placing thetransducer at the cardiac apex & aiming upward & medially.

10. 4 chamber view in 2 dimensional scan

11. Para-sternal long axis

12. Para-sternal short axis

13. Apical 4 chamber view

14. Para-sternal short axis (at Mitral valve level)

15. c) Doppler echocardiography (Color, Pulse wave) : * Changing in the frequency of the sound waves are reflected from moving objects, this change dependson the velocity of the reflecting surface. * RBCs are used as reflecting surface & the velocity of the blood flow can be measured.

16. Doppler flow measurements are used to : 1- Measure cardiac output or Lt. to Rt. shunt. 2- Detect & quantify valvular regurgitation. 3- Quantify pressure gradients across stenotic valves. 4- Quantify flow.

17. 3- Trans-Esophageal Echocardiography : * By placing the U.S. probe in the esophagus immediately behind the Lt. atrium, so it will view the heartfrom behind.

18. Trans-Esophageal Echocardiography (A = normal descending thoracic aorta)

19. Thank You