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Prof. Dr. H.M. Arief Gella, Sp.

Rad(K)
Dr. Andi Darwis, Sp.Rad
Cardiac Anatomy
 The methods in assessment of
cardiac enlargement is by measuring
the CTR (cardiothoracic ratio)
 CTR should not exceed 50%
 CTR increased in the elderly
 CTR may be increased in the neonate
Cardiac Size
Cardiac Size
Here is a heart that is larger than 50% of the cardiothoracic ratio, but it is still a normal heart.
This is because there is an extracardiac cause for the apparent cardiomegaly.
On the lateral film, the arrows point to the inward displacement of the lower sternum in
a pectus excavatum deformity.
Here is an example of a heart that is less than 50% of the CTR,
but the heart is abnormal. This is recognizable because there is
an abnormality of the heart contour (yellow arrows).
Right ventricular enlargement
Left ventricular enlargement
Five States of The Pulmonary Vasculature
 Normal
 Pulmonary venous hypertension
 Pulmonary arterial hypertension
 Increased flow
 Decreased flow
What We’re Going to Evaluate
1. Right descending pulmonary artery
2. Distribution of flow in the lung
 Upper versus lower lobes
 Central versus peripheral
The Pulmonary Vasculature
 Normal
 Pulmonary venous hypertension
 Pulmonary arterial hypertension
 Increased flow
 Decreased flow – mostly unrecognizable
even when it is present
Review
Tetralogy of Fallot: Classic Findings
A. Coeur en sabot with characteristic elevation of the apex is seen [black arrow]. The cardiac waist is
narrow [long white arrow] because of the absence of poststenotic pulmonary artery dilatation.
The pulmonary vasculature is decreased, and the aortic knob is prominent [short white arrow].
B. Lateral view demonstrates the prominent right ventricle [arrow]
Cyanotic Newborn
ASD
VSD
PDA
Severe PAH 2° ASD
Mitral Stenosis
Combined MS & MI
Aortic Stenosis
Aortic Insufficiency
Combined AS & AI
Hypertensive Heart Disease (HHD
Cor Pulmonale and Pulmonary Hypertension
The main pulmonary artery segment [arrowhead] is dilated, and the peripheral vessels [arrows] are
narrowed in a patient with longstanding emphysema. Enlargement of the right heart is seen most
clearly on lateral view.
Early Congestive Heart Failure
Acute intraalveolar pulmonary edema in patient with left heart failure.
Note the central distribution of edema fluid ‘batwing appearance’
in the upper and lower zone of the lung.
Ballooning
C
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Stenting