the chest x-ray still common in patient portable imaging ‘morning portables’ pre-op post-op out...
TRANSCRIPT
The Chest X-ray
• Still common• In patient• Portable imaging
• ‘Morning Portables’• Pre-op• Post-op• Out patient
• Still effective but possibly overused
http://cdn.lifeinthefastlane.com/wp-content/uploads/2012/08/CXR-AP.jpghttp://lifeinthefastlane.com/investigations/cxr-normal/
Right AtriumRight Ventricle
Right Ventricle
Left Ventricle Left VentricleLeft Atrium
Left Atrium
The Chambers
The Pulmonary and Aortic Vessels
Main Pulmonary ArteryRDPA Main Pulmonary ArteryLDPA
Aortic Arch Aortic Arch
Descending Aorta Descending Aorta
This Lecture
• Pulmonary Hypertension• Ventricular Septal Defect• Mitral Stenosis vs Mitral Regurgitation• Aortic Stenosis
Pulmonary HTN
• Increase in pulmonary vascular resistance
• Mean pulmonary artery pressure (PAP) >25mmHg at rest• At least 30 mmHg during exercise• Mean pulmonary wedge pressure < 15mmHg
Causes
• Group 1• Idiopathic• Pulmonary Arterial Hypertension
• Group 2• Left Heart Disease• Pulmonary Venous Hypertension
• Group 3• Hypoxemia• COPD
• Group 4• Group 5
Clinical Indications
• Dyspnea on exertion
• Dizziness
• Syncope
• Angina
Radiographic Indicators
• Prominent main pulmonary artery• Convex shadow along the left cardiac border (PA)
• Right ventricle enlargement• Increased cardiac border in contact with anterior chest wall
(Lat)
• Right descending pulmonary enlargement• Transverse diameter is greater than 16mm
• Pruning of peripheral pulmonary vessels• Abrupt tapering of distal pulmonary vessels with loss of side
branches
• Pleural effusion/Pulmonary Edema
Case courtesy of Dr Frank Gaillard, Radiopaedia.org
Prominent Main Pulmonary Artery and Trunk
Enlarged RDPA
Pleural Effusion
http://posterng.netkey.at/esr/viewing/index.php?module=viewing_poster&task=viewsection&pi=100743&ti=311759&searchkey=
Enlarged Right Ventricle
Enlarged Pulmonary Trunk
Miniati et al. Accuracy of chest radiography in predicting pulmonary hypertension:A case-control study. M. Miniati et al. / Thrombosis Research 133 (2014) 345–351
http://www.vcuthoracicimaging.com/Historyanswer.aspx?qid=40&fid=1
Ventricular Septal Defect
• Holes in the ventricular septum• Conoventricular• Perimembranous• Inlet• Muscular
• Most common congenital cardiac malformation• Up to 50% in congenitally malformed hearts
Causes
• Can exist in isolation
• Or existing with other malformations:• Tetralogy of Fallot• Double outlet right ventricle• Transposition• Univentricular hearts
Clinical Indications
• Dependent on size• May be asymptomatic• May be cyanotic
• Retardation of growth• Pulmonary HTN• Pulmonary edema• Wheezing• Tachypnea
Radiographic Indicators
• Cardiomegaly• Can be difficult to diagnose due to the thymus
• Increased pulmonary vascular markings
Normal
http://www.scielo.br/scielo.php?pid=S0100-39842006000600012&script=sci_arttext&tlng=en
Ventricular Septal Defect
http://radiopaedia.org/articles/ventricular-septal-defect-1
Normal Cardiomegaly
RADIOLOGIC CLINICS OF NORTH AMERICAVOLUME 37 * NUMBER 6 * NOVEMBER 1999
Ventricular Septal Defect
http://radiopaedia.org/cases/ventricular-septal-defect
Case courtesy of Dr Frank Gaillard, Radiopaedia.org
Spicer et al. Orphanet Journal of Rare Diseases (2014) 9:144
Tetralogy of Fallot
http://radiopaedia.org/cases/tetralogy-of-fallot-1">Tetralogy of Fallot
Ventricular Septal Defect
Right Ventricular outflow track obstruction
Overriding Aorta
Right Ventricular Hypertrophy
Let’s Think What Happens
Mitral Stenosis
• Leaflet thickening resulting in narrowing of the mitral valve.
• Causes• Rheumatic Fever
• Common in developing countries• Degenerative
• Common in developed countries
Healthy Mitral Valve Mitral Valve Stenosis
Fish Mouth Appearance
Mitral Regurgitation
• Systolic retrograde flow from the left ventricle into the left atrium.
• Causes• Non-Ischemic
• Degenerative• Endocarditis• Rheumatic
• Ischemic
http://www.vetmed.ucdavis.edu/vmth/small_animal/cardio_kittleson/cases/case9/figures.htm
Healthy Mitral Valve
http://nethealthbook.com/cardiovascular-disease/heart-disease/mitral-valve-disease/
Mitral Valve Prolapse
Clinical Indicators
• Dyspnea
• Exercise Intolerance
• Long Murmur
• Pulmonary HTN
Radiographic Indicators
• Left atrial enlargement• Double Density• Splayed Carina
• Decreased aortic knob
LALV
RVRA
LA
LVRVRA
Double Density and Splayed Carina
http://radiopaedia.org/articles/mitral-valve-regurgitation
http://www.learningradiology.com/lectures/cardiaclectures/valvularlesions2012/Valvular%20Lesions%20of%20the%20Heart/Valvular%20Lesions%20of%20the%20Heart.html
http://radiologyinthai.blogspot.com/2010_06_01_archive.html
http://static.wikidoc.org/3/3a/Left-atrial-enlargement-002.jpg
Aortic Stenosis
• Narrowing of the aortic valve.
• Causes:• Age (Calcific AS, Senile)
• Similar to atherosclerosis• Rheumatic Valve • Congenital
Normal Aortic ValveCalcific Aortic Stenosis
http://www.slideshare.net/drranjithmp/echo-assessment-of-aortic-stenosis
Clinical Indicators
• Angina
• Syncope
• Heart Failure
Radiographic Indicators
• Aortic Valve Calcification
• Prominent Ascending Aorta
• Left Ventricular Enlargement
http://www.learningradiology.com/archives2011/COW%20480-aortic%20stenosis/ascorrect.htm
Ascending aorta projects farther than right atrium
Normal Descending Aorta
Calcified Aortic Valve
http://www.learningradiology.com/archives04/COW%20118-Aortic%20Stenosis/ascorrect.htm
Where are those valves?
A
M
http://web.stanford.edu/dept/radiology/radiologysite/site141.html
AM
Aortic Valve
Mitral Valve
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