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The Heart Shadow in the Mediatinum

The Heart Shadow in the Mediatinum



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Published by Rolando Reyna
radiologia de torax
radiologia de torax

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Categories:Types, School Work
Published by: Rolando Reyna on Jan 03, 2009
Copyright:Attribution Non-commercial


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On a chest radiograph, the central mediastinum area is occupied by alarge radio-opaque shadow termed the
central mediastinal shadow
which is the anatomical location of the
great vessels
. If anyheart disease is suspected, it is very important to carefully examine itssize, position and shape. Enlargement of the heart shadow might indicatethe presence of a cardiac problem such as heart failure following amyocardial infarction. However, the heart shadow is variable in shapeeven in normal subjects, mainly due to the wide variation in body build of different people. Additionally, respiration will also affect the heart shadow.Using the image above as a key, examine the
border of the centralmediastinal shadow.
In its superior parts, the right margin of the shadow represents the
superior vena cava
 (1). This is a large vein which receives blooddraining from the upper part of the body ie head, neck, upper limbs andpart of the upper chest. Inferior to the superior vena cava, the border isformed by the
right atrium
 (2)of the heart.Inferior to the right atrium, a small part of the
inferior vena cava
 cansometimes be identified as it enters the chest through the diaphragm,prior to returning blood to the heart(3).Now look at the left border.The left border of the central mediastinal shadow is formed superiorly bythe prominent left projecting shadow of the
arch of the aorta
 (4), alsoknown clinically as the
aortic knuckle
.Immediately inferior to the aortic arch is a shadow formed by the
leftpulmonary trunk
 (5). Lateral to this shadow, a larger white shadowwithin the lung field is the
left pulmonary artery
 (6)shadow.In a more inferior direction, the left border of the central mediastinalshadow is composed of the left margin of the heart shadow.In its superior region, the heart shadow is formed by the tip of the
of the left atrium(7). Below the auricular shadow, the border isrepresented by the
left ventricle
 (8)of the heart.The point where the cardiac shadow meets the diaphragmatic shadow iscalled the
left cardiophrenic angle
The right heart structures
By marking a radiograph in the appropriate areas, it is possible to traceout the anatomical course of the vessels connected to the right side of theheart. You will be required to know the anatomy of these vessels.Note the position of the
superior vena cava
 (A). The traced outlineshows this vessel to lie to the right of the aortic knuckle. The right heartshadow is formed by the
right atrium
 (B). Most of this atrium is projectedto the posterior on the PA film and thus a relatively small area may beseen on this outline. Note the approximate position of the
right auricle

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