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Chest radiograph in
cardiovascular disease
Dr. Jayanta Kr. Gogoi
Ideal x-ray
 Proper exposure
 Proper centering
 Proper labeling
Proper exposure
 A well penetrated chest X-ray is one
where the vertebrae are just visible
behind the heart.
 Over expos...
Proper centering
 The clavicle should be at the same level
 Clavicles should be equidistant from
the midline.
Proper labeling
 The side determination
◦ Label L or R
◦ Apex of heart on left
◦ Fundal gas shadow on left
◦ Right dome o...
How to read a chest x-ray
 View (PA, AP, lat)
 Exposure
 Centralization
 Position of trachea
 Skeletal structures
 L...
Describe a normal chest x-ray
 This is a PA view of the chest with normal
exposure, proper centering and without any
appa...
Skeletal structure abnormalities
 Kyphosis, scoliosis
 Crowding or widely spaced ribs
 Absence of clavicle
 Erosion of...
Skeletal
deformity
Absent clavicle Scoliosis
RIB NOTCHING  MM, Br Ca, HPT
CERVICAL RIB
Lung field
 Accentuated pulmonary arteries
 Distension of pulmonary arteries
 Accentuation of bronchial pattern
 Promi...
Hilar shadows
 PA, PV, bronchi, lymph gland,
lymphatics, connective tissue.
 The lung field is divided in three zones
◦ ...
Lung fields
 2nd CC
 4th CC
LUNG FIELDS
Cardiothoracic ration
 Ratio between max diameter of heart to
max internal diameter of chest.
 Normal ≤ 1:2
 2/3 of car...
Borders of heart
BORDERS OF HEART
 Right border:
◦ SVC
◦ RA
 Left border:
◦ Aortic arch
◦ Pulmonary trunk
or LPA (bay)
◦ LAA
◦ LV
Cardiac enlargement
 Left atrial enlargement
◦ Straightening of the left border of heart.
◦ Prominent LAA
◦ Double contou...
Double contour of rt border
LA enlargement in MS
LA enlargement AP and Lat view
RA enlargement
 enlarged, globular heart
 narrow vascular pedicle
 gross enlargement of the right atrial
shadow, i.e. i...
Causes of RAE
 raised right ventricular pressures
◦ pulmonary arterial hypertension
◦ cor pulmonale
 valvular disease
◦ ...
RAE
RV enlargement
 Shifting of apex to the left (up outward)
 Increase transverse diameter of heart
 Lat view- obliteratio...
RVE in PS
RVE and lat view
LV enlargement
 Increase transverse diameter
(cardiomegaly)
 Apex shift outward and downward
diaphragm
 Elevation-
◦ collapse or fibrosis, ascites, pregnancy, dia.
Palsy, abd mass, liver abscess
 Depression-
◦ Emp...
Soft tissue abnormality
 Chest wall
 Calcified lymph nodes
 Breast malignancy
 SOL of lung
Chest X-ray in Cardiology
Pulmonary edema (PVH)
description
 This is a PA view of the chest with normal
exposure, proper centering and without any
apparent bony abnormal...
PVH stages
 Stage I – Redistribution
◦ prominent upper lobe vessels
 When there is redistribution of pulmonary blood flow
there will be an increased artery-to-bronchus ratio in the
upper an...
Stage II - Interstitial edema
 When fluid leaks into the peripheral interlobular septa it is seen as
Kerley B or septal l...
Stage III - Alveolar edema
 This stage is characterized by continued fluid
leakage into the interstitium, which cannot be...
KERLEY A LINES
Kerley’s C lines
Kerley’s B lines
A= Apex
B= base
C= center
Kerley lines
Pulmonary artery hypertension
 Main pulmonary artery usually prominent
 Right and left pulmonary arteries large and
tape...
PAH
Increase Qp (pulmonary flow)
 Prominent MPA, RDPA
 Pulmonary plethora
◦ Vascular markings of lung fields can be
traced u...
Cardiac temponade
 there can be globular enlargement of the cardiac
shadow giving a water bottle configuration
 widening...
 C. temponade
 Pacemaker
X ray
C X-RAY of CONGENITAL HEART DISEASE
CHD
ASD
 can be normal in early stages +/- when the ASD is
small signs of increased pulmonary flow (shunt
vascularity) enlarg...
CHD 2
CHD
VSD
 The chest radiograph can be normal with a small
VSD.
 Larger VSDs may show cardiomegaly (particularly
left atrial e...
PDA
PDA
 Chest radiographic features may vary depending on
whether it is isolated or associated with other cardiac
anomalies ...
CHD4
TAPVR
 The right heart is prominent in TAPVR because of the
increased flow volume, but the left atrium remains
normal in ...
TOF
 Boot
shaped
heart
TOF
 Plain films may classically show a "boot shaped"
heart with an upturned cardiac apex due to right
ventricular hypert...
THANK YOU..
chest radiology in cardiovascular disease
chest radiology in cardiovascular disease
chest radiology in cardiovascular disease
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chest radiology in cardiovascular disease

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chest xray in cardiology dept. from practical point of view

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chest radiology in cardiovascular disease

  1. 1. Chest radiograph in cardiovascular disease Dr. Jayanta Kr. Gogoi
  2. 2. Ideal x-ray  Proper exposure  Proper centering  Proper labeling
  3. 3. Proper exposure  A well penetrated chest X-ray is one where the vertebrae are just visible behind the heart.  Over exposure- black lung field clear vertebral bodies  Underexposure- hazy lung field
  4. 4. Proper centering  The clavicle should be at the same level  Clavicles should be equidistant from the midline.
  5. 5. Proper labeling  The side determination ◦ Label L or R ◦ Apex of heart on left ◦ Fundal gas shadow on left ◦ Right dome of diaphragm placed higher than left ◦ Aortic knuckle on left *(NOT for dextrocardia with Situs inversus)
  6. 6. How to read a chest x-ray  View (PA, AP, lat)  Exposure  Centralization  Position of trachea  Skeletal structures  Lung fields including blood vessels and pleura  Cardiovascular silhouette  Costophrenic and cardiophrenic angles  Soft tissue abnormalities  Final diagnosis or conclusion
  7. 7. Describe a normal chest x-ray  This is a PA view of the chest with normal exposure, proper centering and without any apparent bony abnormality. The lung fields are clear with normal bronchovascular markings; cardiovascular silhouette is within normal limit with normal cardiothoracic ratio. Mediastinum, costophrenic and cardiophrenic angles, domes of the diaphragm and soft tissue shows no abnormality.
  8. 8. Skeletal structure abnormalities  Kyphosis, scoliosis  Crowding or widely spaced ribs  Absence of clavicle  Erosion of clavicle  Rib erosion  Rib notching  Presence of cervical rib
  9. 9. Skeletal deformity Absent clavicle Scoliosis
  10. 10. RIB NOTCHING  MM, Br Ca, HPT
  11. 11. CERVICAL RIB
  12. 12. Lung field  Accentuated pulmonary arteries  Distension of pulmonary arteries  Accentuation of bronchial pattern  Prominent lymphatic vessels  Thickened alveolar septum
  13. 13. Hilar shadows  PA, PV, bronchi, lymph gland, lymphatics, connective tissue.  The lung field is divided in three zones ◦ Upper, middle and lower ◦ Do not corresponds with lobes of lung
  14. 14. Lung fields  2nd CC  4th CC
  15. 15. LUNG FIELDS
  16. 16. Cardiothoracic ration  Ratio between max diameter of heart to max internal diameter of chest.  Normal ≤ 1:2  2/3 of cardiac shadow lies on the left.  (a+b)/(c+d)
  17. 17. Borders of heart
  18. 18. BORDERS OF HEART  Right border: ◦ SVC ◦ RA  Left border: ◦ Aortic arch ◦ Pulmonary trunk or LPA (bay) ◦ LAA ◦ LV
  19. 19. Cardiac enlargement  Left atrial enlargement ◦ Straightening of the left border of heart. ◦ Prominent LAA ◦ Double contour of rt border of heart (upper outer border is LA) ◦ Widening of carinal angle ◦ Posterior displacement of barium filled esophagus (rt lat view)
  20. 20. Double contour of rt border
  21. 21. LA enlargement in MS
  22. 22. LA enlargement AP and Lat view
  23. 23. RA enlargement  enlarged, globular heart  narrow vascular pedicle  gross enlargement of the right atrial shadow, i.e. increased convexity in the lower half of the right cardiac border
  24. 24. Causes of RAE  raised right ventricular pressures ◦ pulmonary arterial hypertension ◦ cor pulmonale  valvular disease ◦ tricuspid regurgitation ◦ tricuspid stenosis ◦ Ebstein's anomaly  atrial septal defect (ASD)  atrial fibrillation (AF)  dilated cardiomyopathy
  25. 25. RAE
  26. 26. RV enlargement  Shifting of apex to the left (up outward)  Increase transverse diameter of heart  Lat view- obliteration of retrosternal space
  27. 27. RVE in PS
  28. 28. RVE and lat view
  29. 29. LV enlargement  Increase transverse diameter (cardiomegaly)  Apex shift outward and downward
  30. 30. diaphragm  Elevation- ◦ collapse or fibrosis, ascites, pregnancy, dia. Palsy, abd mass, liver abscess  Depression- ◦ Emphysema, pneumothorax
  31. 31. Soft tissue abnormality  Chest wall  Calcified lymph nodes  Breast malignancy  SOL of lung
  32. 32. Chest X-ray in Cardiology
  33. 33. Pulmonary edema (PVH)
  34. 34. description  This is a PA view of the chest with normal exposure, proper centering and without any apparent bony abnormality.  Lung fields shows bat-wing appearance of confluent shadows which extends from the hilum to mid and upper zones.  Cardiac silhouette is enlarged.  No mediastinal shifting, both CP angles are obscured.
  35. 35. PVH stages  Stage I – Redistribution ◦ prominent upper lobe vessels
  36. 36.  When there is redistribution of pulmonary blood flow there will be an increased artery-to-bronchus ratio in the upper and middle lobes Artery-to-bronchus ratio
  37. 37. Stage II - Interstitial edema  When fluid leaks into the peripheral interlobular septa it is seen as Kerley B or septal lines. Kerley-B lines are seen as peripheral short 1-2 cm horizontal lines near the costophrenic angles. These lines run perpendicular to the pleura.
  38. 38. Stage III - Alveolar edema  This stage is characterized by continued fluid leakage into the interstitium, which cannot be compensated by lymphatic drainage. This eventually leads to fluid leakage in the alveoli (alveolar edema) and to leakage into the pleural space (pleural effusion).
  39. 39. KERLEY A LINES Kerley’s C lines Kerley’s B lines A= Apex B= base C= center Kerley lines
  40. 40. Pulmonary artery hypertension  Main pulmonary artery usually prominent  Right and left pulmonary arteries large and taper rapidly  Peripheral pulmonary arteries are narrow and inconspicuous  Diffuse oligemia of the lungs
  41. 41. PAH
  42. 42. Increase Qp (pulmonary flow)  Prominent MPA, RDPA  Pulmonary plethora ◦ Vascular markings of lung fields can be traced up to lateral third of it.  End-on vessels (3 in rt, or 5 in both)
  43. 43. Cardiac temponade  there can be globular enlargement of the cardiac shadow giving a water bottle configuration  widening of the subcarinal angle without other evidence of left atrial enlargement may be an indirect clue  lateral CXR may show a vertical opaque line (pericardial fluid) separating a vertical lucent line directly behind sternum (epicardial fat) anteriorly from a similar lucent vertical lucent line (pericardial fat) posteriorly; this is known as the Oreo cookie sign
  44. 44.  C. temponade
  45. 45.  Pacemaker X ray
  46. 46. C X-RAY of CONGENITAL HEART DISEASE
  47. 47. CHD
  48. 48. ASD  can be normal in early stages +/- when the ASD is small signs of increased pulmonary flow (shunt vascularity) enlarged pulmonary vessels  upper zone vascular prominence  vessels visible to the periphery of the film  eventual signs of pulmonary arterial hypertension  chamber enlargement right atrium  right ventricle  note: left atrium is normal in size  note: aortic arch is small to normal (narrow pedicle)
  49. 49. CHD 2
  50. 50. CHD
  51. 51. VSD  The chest radiograph can be normal with a small VSD.  Larger VSDs may show cardiomegaly (particularly left atrial enlargement although the right and left ventricle can also be enlarged).  A large VSD may also show features of pulmonary edema, pleural effusion and/or increased pulmonary vascular markings  Wide pedicle
  52. 52. PDA
  53. 53. PDA  Chest radiographic features may vary depending on whether it is isolated or associated with other cardiac anomalies and with direction of shunt flow (right to left or left to right).  Can have cardiomegaly (predominantly left atrial and left ventricular enlargement if not complicated). Obscuration of the aortopulmonary window and features of pulmonary oedema may be evident  Wide pedicle
  54. 54. CHD4
  55. 55. TAPVR  The right heart is prominent in TAPVR because of the increased flow volume, but the left atrium remains normal in size. Types I and II result in cardiomegaly.  The supracardiac variant (type I) can classically depict a snowman appearance on a frontal chest radiograph, also known as figure of 8 heart or cottage loaf heart 2-3.  The dilated vertical vein on the left,  brachiocephalic vein on top, and  superior vena cava on the right form the head of the snowman; the body of the snowman is formed by the enlarged right atrium
  56. 56. TOF  Boot shaped heart
  57. 57. TOF  Plain films may classically show a "boot shaped" heart with an upturned cardiac apex due to right ventricular hypertrophy and concave pulmonary arterial segment. Most infants with TOF however may not show this finding .  Pulmonary oligemia due to decreased pulmonary arterial flow. Right sided aortic arch is seen in 25%.
  58. 58. THANK YOU..

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