radiology in chest (cardiac)

1. HEART IMAGING
NUR FARRA NAJWA
082015100035

2. PLAIN X-RAY
• Gives information
– Cardiac size
– Chamber enlargement
– Pericardial effusion
– Lung vasculature
changes

3. ECHOCARDIOGRAPHY
• Via transthoracic route
• Patient position semi-flex and rotated to left
• 2D images
– Cardiac anatomy
– Physiology
• M-mode
– Measurement and timing of cardiac event

5. DOPPLER EXAMINATION
• Study of velocity within cardiac chamber and
outflow tract
• Calculate
– Cardiac output
– Ejection fraction

6. CT SCAN
• Detecting atherosclerotic diseases (calcium
scoring system)
– Myocardial calcification
– Aneurysmal dilatation
– Dissection
– Cardiac tumors
– Pericardial diseases
– Pericardial tumor

7. MRI
• Most pathology
• Assess
– Velocity in chamber and outflow tract
– Cardiac output
– Ejection fraction
– Cardiac tumor and pericardial diseases
– Quantify shunt in CHD
• Perfusion scan (MI)

8. CT RATIO
• Estimating cardiac
enlargement
• CT = R + T / TD
• Normal –
• adults : 50% ,
neonates : 60%
• Cardiomegaly is
diagnosed if
exceeding 50% on
frontal chest PA
radiograph

9. CARDIOMEGALY
• Common cause
– Valvular heart diseases
– Pericardial diseases
– Myocardial diseases
– CHD
• False increased CT ratio
– Poor inspiration
– Supine or prone position
– AP x ray

10. ENLARGED HEART
• Multiple valve diseases
• Pericardial effusion
• Dilated cardiomyopathy
• Ebstein anomaly
• Cor pulmonale
SMALL HEART
• Constrictive pericarditis
• Addisonian diseases
• Pulmonary emphysema
GROSS CAUSE

11. CARDIAC ENLARGEMENT

12. CARDIAC MARGIN

13. LAE
• Double atrial shadow
• Carina splaying
• Left atrial appendages
enlarge
• Indention of anterior
thoracic esophagus

14. LVE
• Apex angle downward and
outward
• Angle obtuse

15. RAE
• Lateral prominence of
right border
• > 5cm from midline @
2.5cm from right
vertebral border
• Associate with increase
convexity
• Lateral x ray: obliterated
retrosternal lucency

16. RVE
• Apex outward and
upwards
• Angle is acute

17. MS
• LAE
• Calcification
( curvilinear
calcification)
• Changes in pulmonary
vasculature as increase
in left atrial pressure

18. DISEASES OF PERICARDIUM-
PERICARDITIS
• X- ray
– Non specific cardiomegaly
– Filling of retrosternal space
– Flask or water bottle cardiac figure
• ECHO: anechoic collection
• CT: thickening of pericardium with hypodense
fluid collection

20. VASCULAR PATTERN

21. NORMAL

22. PAH
• Features seen when
> 30 mmhg
• Secondary to
intrinsic lung
diseases
• Large main and
central pulmonary
arteries with pruned
tree appearance

23. PVH
• Secondary to MS
• Upper lobe vessel
become prominent and
diametre >3mm (upper
lobe diversion)

24. PLETHORA
• Due to left to right shunt
– ASD
– VSD
– PDA
• Above normal pulmonary
flow
• Enlarged pulmonary
vessel in upper and lower
lobe

25. OLIGEMIA
• Due to right to left
shunt
• State of below normal
flow
• Decrease vascular
shadow
• Associated with
cyanosis

26. CONGENITAL HEART DISEASES

27. TOF
• “cour en sabot”
silhouette
• Pulmonary oligemia
• Enlarged ascending
aorta
• Later biventricular
heart enlargement

28. VSD
• Left atrium enlarged
• Hypertrophy of left and
right ventricle
• Increased pulmonary
vascular marking

29. ASD
• Enlargement of right
atrium and right
ventricle
• Pulmonary vascular
prominence

30. CARDIAC TUMORS
METASTASIS
– Bronchogenic
carcinoma
– Mediastinal tumor
– Melanoma
– Lymphoma
PRIMARY TUMOR OF
HEART
– Myxoma
• Most common
• Interatrial septum
• ECHO: polypoid and
mobile mass with
heterogenous
echotexture