CARDIAC IMAGING

X-RAY
DR. MOHAMAD MATAR

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face the
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8- 10 Post Ribs

orientation 1
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 CARDIOMEGALY
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film
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weather it's
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in Pediatric
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normal cardiothoracic Index { 50%
- -

in adults SSI
& < in pediatric
NB .
the film has to be in
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ra - Si
PA film
standing position & .

Cardiomegaly
 ⑤
LT ATRIUM ENLARGEMENT
f- NB .
Global
Cardiomegaly is measured
by cardiothoracic index indicates cardiac
- - - - - -
any abnormality in
general .

* Causes I
cardiomegaly - mitral stenosis / regurgitation
distinguished
There can be via

Tricuspid Abnormality
c×f ,

-
Aortic Valve
Abnormality I ✗ ray
Al -
11 - if
-

Any other cardiac dz .

( entrapment ) 11
-
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Causes ol LA
Enlargement . . .

• acquired ☒
• mitral stenosis PP LA .
↑ in sized LA
→ dilation &

• mitral regurgitation insufficiency (or

late-stage ) in the ND . in
early stage & U .

regurg
-

→ no 47
enlargement .

• left ventricular failure PP hoon due to

1¥ the

• left atrial myxoma lead to

F sized
→
Atrium the

• congenital or due to valve

abnormality →
LA-my✗omg

• ventricular septal defect (VSD) (common )

I

• patent ductus arteriosus (PDA)

 Direct visualisation of the enlarged atrium includes: Direct
signs d LA
-
Enlai .

g- .

Indirect
Double density sign
←

¥ >I £1 .tl Double Border the left side

Sign
= on .
.

entasis posteriorly
when the right side of the left atrium pushes into the adjacent lung, and becomes
-

↳ dilation

→ shadow on the
lt.ie visible superimposed or even beyond the normal right heart border (known as atrial
escape)
a similar appearance can be caused by the right superior pulmonary vein in
patients without atrial enlargement .
oblique measurement : of greater than 7cm measured from mid point of left main
bronchus to the right border of the left atrium (this requires a double density sign of
course)
this is thought to be the most reliable sign on chest radiography
convex left atria appendage:
normally the left heart border just below the pulmonary outflow track should be flat or
slightly concave
 Indirect signs include:
•splaying of the carina, with increase of the tracheal bifurcation angle to over 90
degrees
-7m
• This refers to both the inter-bronchial angle (i.e angle formed by the central
-
,

there's too much

variability
axis of the left and right main bronchi) and the subcarinal angle.
& there's no sharp at
point
to determine • Both are inaccurate and dependent on radiographer technique, inspiration and
the
enlargement
angle .
body habitus .
d Ii é - * • The mean and range of both measurements vary widely in normal individuals.
Breath £5s * • interbronchial angle: normal mean 67-77° (with a range 34-109°) 
• subcarinal angle: normal mean 62-73° (range 34-90°)
•
"
d
Depth breath

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•posterior displacement of the left main stem bronchus on lateral radiograph

.

-
-
Shallow
Deep
Breath Breath • right and left bronchi therefore do not overlap, but rather form an upside
down 'V', sometimes referred to as the walking man sign 5 reversed
sign
= u
.
#

•superior displacement of the left main stem bronchus on frontal view

-

•posterior displacement of a barium filled esophagus or nasogastric tube

-
Carinal angle

normal
0 62--71
i. %
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open
heel
cardiomegaly
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valve
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sign
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Double Border -
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Double Border

sign
= Double

density
sign
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Border

cardiomegaly
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Post .
shifting I
esophagus
in Brain study CTA all
LT ATRIAUM

& appendage
vexity
.

the Lt Border
.

( LA#gr)
• Double density sign
62 73
☆
• Carinal angle >90.- normal -

• Oblique measurement >7cm.

-
RA
entry § IT
-

• Convex LT atrial appendage.

-
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RT atrium ⇐
ñn_
• RT heart boarder enlargement.
I
• Enlarged shadow of IVC &0SVC .

+ Cwnaghy
Causes

• raised right ventricular pressures

• pulmonary arterial hypertension
§
• cor pulmonale

• valvular disease
• tricuspid regurgitation
• tricuspid stenosis
• Ebstein's anomaly low position of tricuspid .

• atrial septal defect (ASD)

• atrial fibrillation (AF)
• dilated cardiomyopathy
Radiographic features

• enlarged,-globular heart
•@narrow vascular pedicle above the heath
• gross enlargement of the - right atrial shadow, i.e. increased convexity
in the lower half of the right cardiac border
-

+ SVC & IVC

congested & dilated
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Rt Borde
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.

convexity
( RA )
entry
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Convexity
I Rt
Border
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-
Cardiomegaly

Fig. 17. Marked right atrial dilatation and right ventricular dilatation due to
severe tricuspid regurgitation related to traumatic injury of the tricuspid
 - elderly he 1- H
LT Ventricle Hypertrphy
• LVH itself is not a disease, it is usually a marker for disease involving
the heart.
• Disease processes that can cause LVH include any disease that
increases the0 afterload that the heart has to contract against, and
some primary diseases of the muscle of the heart.

*
Gtobdcadimegety
 • Left ventricular enlargement can be the
result of a number of condition, including:

• pressure overload
• hypertension
• aortic stenosis
• volume overload
→
0 • aortic regurgitation
• mitral regurgitation
• wall abnormalities
• left ventricular aneurysm C common) post infarction .

• hypertrophic cardiomyopathy
 LV
Enlarged
• Bulge in the LT heart boarder,-
- down ward and lateral displacement of
the cardiac apex.
•-Rounded apex.
spaced
"

•&Posterior displacement of heart in lateral x ray. retro cardiac

• Late signs:

on Posterior Bruder is
• LT atrial enlargement
• Pulmonary congestion.

[
• Prominent aortic arch.

5- £0
unfolded aorta

+ venous
congestion .
 rehscwdiacpael
→
LT VENTRICLE

waiag@

5::::
+

Cardiomegaly
+ downward lateral
apex .
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Calcification &
LU
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s
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RT Ventricle Enlargement.
diaphragm

girt
◦-

• AP view:
:& #
ij③
• Up ward elevation of cardiac apex. •
⇐
• Transverse position of the heart.
enlarged → Apa elevated
• Lateral view demonstrates:
• filling of the retrosternal space As &

-2
It

• rotation of the heart posteriorly LVH %

apex t

A ⑧ i a
RVHÉ↳-
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ankim②
Right ventricular enlargement can be the result of a number of
conditions, including :

• pulmonary valve stenosis

• pulmonary artery hypertension
• atrial septal defect
• tricuspid regurgitation ( late )
stage
• dilated cardiomyopathy
• ASD
• VSD
• anomalous pulmonary venous drainage
• High altitude
• Cardiac fibrosis
• Chronic obstructive pulmonary disease (COPD)
• Athletic heart syndrome
Rvenkgn④

elevated

2- apex
 RT VENTRICLE (PS) that has
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& apex
+
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congestion pinny
.

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Tranter #
elevated
cardiomegaly < apd
 Congenital abnormality , primary RT ventricle enlargement

Rm fa

cardiomegaly -

Zo - elevation
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