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Bronchogenic cyst

Cystic fibrosis
Normal CXR post heart and lung
transplant
Post transplant complications ,
bronchiolitis obliterance
Congenital diaphragmatic hernia
fluid in the bowel
Congenital diaphragmatic hernia
air in the bowel
Congenital diaphragmatic hernia
post op pneumothorax
Congenital Lobular Emphysema
c
y
s
t
i
Cystic Hygroma
HMD
Intestinal lobular emphysema
pneumothorax
Tension pneumothorax
Pneumonia
CROUP
Epiglottitis
Thymus on CXR
Thymus on CXR
Thymus on CXR
VSD
VSD
VSD: Radiographic Findings
Conventional chest film findings are usually evident
only in patients with medium to large sized defects
↑ pulmonary vascularity ( pulmonary plethora)
↑ pulmonary artery outflow tract
RV enlargement
Enlarged left atrium & posterior displacement and
elevation of left main stem bronchus.
Signs of pulmonary oedema (CHF)
ASD
ASD: Radiographic Findings
CXR in infants is usually normal.
↑ pulmonary vascularity (pulmonary plethora) .
Prominent main pulmonary trunk.
RA & RV dilatation, apex turned upward,rotation of
mediastinal contour to the left.
Absent SVC contour, rotated over the spine.
No enlargement of LA, due to immediate
decompression of blood to RA during systole and
diastole.
Atrial Septal Defect (Eisenmenger situation)
Ventricular Septal Defect
(Eisenmenger situation)
Eisenmenger Physiology
LT to RT shunt ➨↑volume of blood in PA ➨
↑pressure ➨ PA hypertrophy & endothelial
thickening ➨ pulmonary hypertension
Pulmonary pressure >systemic pressure ➨
RT to LT shunt ➨ cyanosis
“pruned” appearance of PBF on CXR:
dilated central arteries with diminutive peripheral
arteries
PDA
Patent Ductus Arteriosus
Comprise 8-10% of CHD.
AO
There is systemic-pulmonary
shunt between the LVE RA
descending aorta and the
PDA
left pulmonary artery just
distal to the left subclavian LAE RV
artery

PV ↑ PA ↑
PDA: Radiographic Findings
In neonates :
pulmonary plethora
left atrial enlargement
left ventricular enlargement
CHF
In older children:
pulmonary plethora
left atrial enlargement
left ventricular enlargement
Enlarged aortic knob is theoretically possible but seldom noted.
In reality no way to differentiate VDS & PDA on CXR in children
closed duct:
calcification
surgical coil or Rashkind umbrella
PDA Coil
PDA Rashkind umbrella
PAPVD
PAPVD
Partial Anomalous Pulmonary
Venous Connection
Pulmonary vein drain to RA, SVC or IVC
Associated with ASD esp. sinus venosus type
CXR: of ASD
Sometimes,anomalous pulmonary vein drain down to
IVC below the diaphragm more commonly on the right
side ➨ SCIMITAR SYNDROME
CXR: curved vessel in the right lower zone which is
widening as it approaches the right cardiophrenic angle,
frequently associated with hypoplasia of the right lung &
mediastinal shift of the heart to the right.
D-TGA
Dextro- TGA
Atrioventricular concordance
ventriculoarterial discordance
incompatible with life unless there is ASD,
VSD or PDA

LA RA

LV RV

PA AO
D-TGA: Radiographic Findings
Normal to increase pulmonary vascularity
Inapparent pulmonary artery segment
Right heart prominence
“Egg-on-side” or “ Apple on string”
appearance
Congenitally Corrected Transposition of
Great Vessels (L-TGA)
Atrioventricular discordance
ventriculoarterial discordance
The levo-transposition of great vessels
The patient is usually acyanotic

RA LA

LV RV

PA AO
Congenitally Corrected L-TGA
L-TGA: Radiographic Findings
Findings are related to the severity of associated intracardiac
lesions:
VSD in 50% of cases
pulmonary stenosis in 50% of cases
single ventricle in 35% of cases
CXR:
often normal , ↓ or ↑ pulmonary vascularity due to associated intracardic
lesions
abnormal fullness (bulge) along the left upper heart border due to the
ascending aorta and RV
If isolated lesion, the child lives normal life
TAPVD Type I
TAPVD
Type I
TAPVD Type I
TAPVC: Radiographic Findings
Types I, II & IV:
pulmonary plethora
right heart enlargement
wide mediastinum➨“snow man”,“figure of 8” configuration
seen in type I
Type III :
normal size heart
pulmonary venous hypertension
If pulmonary venous obstruction happened ➨ pulmonary oedema
If normal heart size + interstitial oedema ➨think of infracardiac
TAPVC
TOF
Tetralogy of Fallot
The most common cause of cyanotic CHD
beyond the neonatal period
Comprise 8-10% of CHD
Four Aspects:
Right ventricular out flow obstruction
pulmonary valve stenosis
infundibular narrowing
VSD
Aorta “overriding” the ventricular system
Right ventricular hypertrophy
TOF: Radiographic Findings
Pulmonary plethora
right ventricular hypertrophy, upturned cardiac
apex, “ boot- shaped”
innapparent pulmonary artery segment
large aorta, right sided aortic arch in 25% of
cases
presence of collateral flow with a reticular pattern
in the upper medial lung field, seen in TOF with
pulmonary atresia
Ebstein’s Anomaly
Ebstein’s Anomaly
< 1% of CHD
Downward displacement of the septal & occasionally the
posterior leaflets of the tricuspid valve ➨ “ atrialization” of the
right ventricle
ASD always present with RT ➨ LT shunt due to poorly
functioning RV
CXR: depends on the degree of dilatation of the right side of
the heart
“box-shaped heart” resembles pericardial effusion
normal or ↓ pulmonary vascularity
Coarctation of Aorta: rib notching
Coarctation of Aorta :Fig of 3
sign
Coarctation
of aorta:
MRA
Coarctation of
aorta: MRA
Congenital Aortic Stenosis
Bicuspid aortic valve
2% of population
If critical stenosis ➨ neonatal CHF, cadiomegaly
If mild stenosis ➨
normal pulmonary vascularity
normal size heart with left ventricular contour
post-stenotic dilatation of ascending aorta
calcification in adult patient with AV stenosis
Coarctation of the Aorta
Occurs just distal to the origin of left subclavian
artery
Comprises 5% of all CHD
Associated with bicuspid aortic valve (80%),
PDA (60%) & VSD (30%)
Other associations: tracheo-oesophageal fistula
& circle of Willis aneurysms
Coarctation of the Aorta:
Radiographic Findings
Inferior rib notching (ribs 3-8) due to hypertrophied
intercostal arteries as collaterals ,rare in a child before 8-
12 years
Normal pulmonary vascularity
Normal size heart with left ventricular contour
Abnormal aortic arch- “figure 3 sign”due to prominent
ascending and descending aorta (post stenotic dilatation)
Reverse “3 sign” with barium in esophagus
MRI can illustrate the exact site & length of the coarctation
Aortic Stenosis
Pulmonary Valve Stenosis
Pulmonary Stenosis
The most common acyanotic lesion, found either
isolated or incombination with other cardiac
lesions
CXR:
post stenotic dilatation of the main PA segment & left
main PA due to “jet” effect of ejecting blood
normal heart size, right ventricular hypertrophy with
upturned cardiac apex
normal pulmonary vascularity
RT sided aortic arch
Heterotaxy
Definitions:
situs-
visceroatrial (position of the atria & abdominal viscera)
bronchial (position of “RT” & “LT” bronchus)
solitus- normal or usual
inversus- mirror image of a group of structures with retention of
the same anterior/ posterior relationships
transposition- reversal of anterior/ posterior relationships
levocardia- left sided cardiac apex
dextrocardia- right sided cardiac apex
mesocardia- midline or central cardiac apex
ectopia cordis- external cardiac structures including the apex
Heterotaxy
viscero-atrial situs
Situs solitus
situs inversus
situs indeterminatus or ambiguous
Bronchial situs
Eparterial bronchus
Hyparterial bronchus
Visceral - Atrial
Situs
SITUS SOLITUS SITUS INVERSUS
NORMAL A

RV RV
RA LV LV RA
LA LA

R L

LV LV
RV LA LA RV
RA RA

DEXROVERSION P LEVOVERSION
S.SOLITUS S.INVERSUS
Visceral - Atrial Situs
Situs solitus (normal) Situs inversus
morphologic RA on the right morphologic RA on the left
morphologic LA on the left morphologic LA on the right
spleen & stomach on the left spleen & stomach on the right
major hepatic lobe on the right major hepatic lobe on the left
usually a left aortic apex usually a right aortic apex
usually a left cardiac apex usually a right cardiac apex
normal A/P relationships normal A/P relationships
normal RT/LT relationships reversed RT/LT relationships
1% incidence of CHD 3-5% incidence of CHD
Kartagener syndrome
Situs inversus
Situs inversus
Visceral - Atrial Situs
Dextroversion of s. solitus Levoversion of s. inversus
morphologic RA on the right morphologic RA on the left
morphologic LA on the left morphologic LA on the right
ventricular concordance ventricular concordance
RV & RA- posterior chambers RV & RA- posterior chambers
normal RT/LT, reversed A/P reversed RT/LT, reversed A/P
spleen & stomach on the left spleen & stomach on the right
major hepatic lobe on the right major hepatic lobe on the left
usually left sided aortic arch usually right sided aortic arch
usually right sided apex usually left sided apex
cardiac apex formed by- RV cardiac apex formed by- RV
95% incidence of CHD 100% incidence of CHD
Dextroversion of s. solitus
Dextrocardia of situs solitus
The position of cardiac mass/apex is NOT
directly related to visceroatrial situs and
may not correspond with it. The apex can
occasionally be directed towards the right
side even with normal visceroatrial situs,
this is described as isolated dextrocardia
or dextrorotation of heart
Visceral - Atrial Situs
Dextroversion of s. solitus Levoversion of s. inversus
morphologic RA on the right morphologic RA on the left
morphologic LA on the left morphologic LA on the right
ventricular concordance ventricular concordance
RV & RA- posterior chambers RV & RA- posterior chambers
normal RT/LT, reversed A/P reversed RT/LT, reversed A/P
spleen & stomach on the left spleen & stomach on the right
major hepatic lobe on the right major hepatic lobe on the left
usually left sided aortic arch usually right sided aortic arch
usually right sided apex usually left sided apex
cardiac apex formed by- RV cardiac apex formed by- RV
95% incidence of CHD 100% incidence of CHD
Levoversion of s. inversus
Levocardia of situs inversus
situs inversus with the cardiac apex lying
on the left called isolated levoctardia, i.e.
the reverse of isolated dextricardia in situs
solitus
Visceral - Atrial Situs
Situs Ambiguous
normal visceral & atrial relationships allowing
each side of the body to be unique is ABSENT
atrial identification & differentiation is NOT
possible
consider whenever cardiac apex & stomach are
located on opposite sites
asplenia & polysplenia
Situs Ambiguous
Asplenia Polysplenia
bilateral RT sidedness bilateral LT sidedness
single atrium with two RT single atrium with two LT
atrial appendages
atrial appendages
bilateral hyparterial bronchi &
bilateral eparterial bronchi bilobed lungs
& trilobed lungs
hepatic symmetry
hepatic symmetry multiple spleens
absent spleen high incidence of azygous
IVC connection to common continuation of IVC
atrium bilateral SVC
bilateral SVC
Situs Ambiguous
Pericardial Effusion
Pericardial Effusion
 On CT: may identify the etiology e.g. mediastinal
malignancy
 On MRI: accurate for diagnosis and also images
chest and mediastinum
 Causes: infective (viral, bacterial, tuberculosis)
uremia, postmyocardial infarctions (Dressler’s
Syndrome) myxoedema, malignancy, bronchial and
mediastinal tumours with pericardial invasion,
collagen vascular disease (systemic lupus
arythematosus, rheumatoid arthritis.