WHO MANUAL OF DIAGNOSTIC IMAGE

Chapter 12 Cardiac

Presenter: R2 謝舒筠
 Cardiac
▪ Recognition of cardiac abnormalities on a CXR depends
on:
1. Changes in the mediastinal silhouette
2. The effect of the abnormality on the lung
vasculature.
 Coarctation of the aorta

▪ Coarctation of the aorta typically occurs at the

isthmus just distal to the arch.

Significantly reduce the

vascular supply to the
trunk and lower limbs
such that collateral
circulation develops via
the intercostal arteries

https://stanfordhealthcare.org/medical-conditions/blood
eart-circulation/coarctation-aorta/causes.html
 CXR of aorta coarctation
▪ The aortic knuckle will appear small and demonstrate
the characteristic reverse “3” appearance.
 Coarctation of the aorta
▪ The enlargement of the intercostal arteries, over time,
causes erosion of the underside of the adjacent ribs,
visible as rib notching.
 Fallot’s tetralogy
▪ The combination of 4 cardiac abnormalities:
1. Overriding aorta
2. Ventricular septal defect
3. Pulmonary stenosis
4. Right ventricular hypertrophy

https://pedctsurgery.ucsf.e
du/conditions--procedures/
tetralogy-of-fallot.aspx
 CXR of Fallot’s tetralogy
▪ A boot shaped cardiac contour
 Cardiomegaly
▪ The CXR heart borders defining the mediastinal contours
correspond to the left ventricle and right atrium.

https://www.chestme
dicine.org/2015/12/si
gns-in-chest-radiolog
y-silhouette-sign.htm
l
Cardiomegaly
▪ Heart size will vary with body habitus.
Reasonable upper limits : females 15.5 cm and males 16 cm
▪ Serial measurement of heart size is best determined
by measuring cardiothoracic ratio(CTR) in PA view.

CTR normal range: 0.42~0.5

CTR > 0.5🡪Cardiomegaly

A = Cardiac size
B = Thoracic diameter
CTR = A/B
LA enlargement
▪ Useful signs of LA enlargement are enlargement of the
left atrial appendage, a double right heart border and
widening of the carina.
▪ An enlarged fibrillating LA may develop mural
thrombus.
 Pericardial effusion
▪ The accumulation of fluid in the potential space between
the two layers of pericardium.
▪ Difficult to appreciate on CXR.

▪ Most obvious signs :

- the shape of the heart to a more rounded contour
- a rapid increase in size of the cardiac silhouette
https://newmexico.networkofcare.org/mh/library/article.aspx?hwid=tp108
Pericardial effusion

normal
Pericardial calcification
▪ Cause of pericardial calcification:
1. Pericarditis (TB, rheumatic fever, viruses)
2.Post trauma
3. Uremia

▪ On a CXR, there is curvilinear calcification on the

surface of the heart.

▪ Should not be confused with calcification of a left

ventricular aneurysm.
Pericardial calcification
▪ Calcification en-face to the X-ray beam is difficult to
appreciate but will be readily apparent on a lateral CXR
Ventricular aneurysm
▪ A ventricular aneurysm is usually the sequel to a
myocardial infarct.

▪ Typically the left cardiac border changes shape

and bulges.

▪ Mural thrombus is often present.

Ventricular aneurysm

Calcification
 Aortic aneurysm
▪ The appearance on a CXR of an aortic aneurysm
depends upon the section of aorta involved.

https://weillcornell.
org/aortic-aneurysm
-and-dissection-rep
air
▪ The ascending aorta forms part of the right mediastinal
contour where aneurysmal dilatation of the ascending
aorta may cause a bulge in the mediastinal silhouette.
▪ Aneurysmal dilatation of the arch of the aorta will
manifest as an enlargement of the aortic knuckle
▪ The descending aorta lies behind the heart not
contributing to the mediastinal contours but its left
border is visible lying adjacent to aerated lung.
▪ Bulging of this contour suggests aneurismal dilatation,
but unfolding of the aorta may mimic the appearance.
Thank you