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RADIOLOGY OF CARDIAC AND VASCULAR STRUCTURES

Cindy Chan, MD

Cardiac Imaging Modalities


Chest radiography Echocardiography Angiocardiography Nuclear Cardiology Magnetic Resonance Imaging Also, computed tomography & cardiac fluoroscopy

Chest Radiograph

Echocardiogram

Angiogram

Nuclear Cardiac Scan

Magnetic Resonance Imaging

CXR
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5 6 7 8 9

Position of the patient (True PA film or off center) Determine right and left markers. Examine the bony skeleton Examine the depth of inspiration and the height of the diaphragm Locate the image of the trachea Examine both lungs for abnormalities Examine the vascular shadows Then examine the cardiac silhouette Look at the neck and the sub-diaphragmatic areas

How to Read a Normal Frontal Chest Radiograph

SVC

Subclavian a. Aortic knob

R pulm a.

Main pulm a. L atrial appendage LV

R atrium

The Older Patient

Dilated aorta with HTN

Abnormal observations, AP view


Dilated aorta in syphilis

Aortic Contour

Abnormal observations, AP view

Pulm HTN

Pulmonary Artery

Abnormal observations, AP view

LAE, with prosthetic MV

Left Atrium

Abnormal observations, AP view

Enlarged Left Ventricle more rounded appearance

How to read a normal lateral chest radiograph

Pulmonary trunk LA RV

LV

IVC

Abnormal observations, LAT view

Right Ventricle

Abnormal observations, LAT view

Left Ventricle

Abnormal observations, LAT view

Left Atrium

The Vessels, Aorta

The Vessels, Aorta

Pulmonary Vasculature

Normal Pulmonary Vasculature

Abnormal Pulmonary Vasculature


Centralization pulmonary artery hypertension Overcirculation increased pulmonary arterial volume Lateralization unilateral increased resistance

Centralization

Pulmonary hypertension chronic PE

Overcirculation

Ventricular septal defect

Lateralization
Westermarks sign

Pulmonary Veins
Pulmonary Venous Hypertension (postcapillary) Cephalization Interstitial edema Airspace (alveolar edema)

Often see in CCF

Cephalization
Upper vessels larger than lower vessels

Interstitial Edema
Kurley B lines (thickened septal lines of secondary pulmonary lobules, from fluid)

Airspace (alveolar) edema

Cardiac Calcifications

Myocardial Calcification

Myocardial Calcification

Pericardial Calcification

Coronary Artery Calcification

Computed Tomography

Cross-Sectional Imaging

CT Scan

Magnetic Resonance Imaging

Radiography of Specific Disorders

Aortic Diseases
Aortic dissection Aortic aneurysm Aortic stenosis Aortic insufficiency Congenital aortic abnormalities

Aortic Dissection - CT

Intimal flap

Aortic dissection - MRI

Aortic dissection -transesophageal echocardiography

Aortic Aneurysm

Aortic Aneurysm

Congenital Aortic Abnormalities


R-sided aortic arch

Double Aortic Arch

Aortic Stenosis
Enlarged ascending aorta Prominent but not enlarged left ventricle Valvular calcification visible on the lateral view

Aortic Stenosis

Aortic Insufficiency
Enlarged ascending and descending aorta Left ventricular enlargement No valvular calcification

Aortic Insufficiency

Mitral Valve Disease


Left Atrial Enlargement Uplifted left main bronchus Double density Enlarged left atrial appendage Posterior convexity of left atrium (lateral view)

Left atrial enlargement

LA sitting on RA = double density

Pulmonary Artery Hypertension


Chronic pulmonary emboli Primary pulmonary hypertension Pulmonary veno-occlusive disease

Primary pulmonary hypertension

Pericardial Effusion

Congenital Heart Disease in the Adult


Atrial septal defect (ASD) Ventricular septal defect (VSD) Pulmonary stenosis Patent ductus arteriosus

Adult Congenital Heart Disease

Large pulm arteries

Atrial septal defect

Coronary artery angiography

Coronary artery angiography

Coronary artery angiography

Heart flipped, s/p pneumonectomy