Plain CXR :PA & lateral view Echocardio-study Radioisotop scan Computed tomography MRI Cardiac cartheritization & angiography.
Size & shape of the heart Pulmonary vessels Aorta. lungs
Hear size usually measured on plain CXR by Cardiothoracic ration ,Normal ratio is less than 50%. On serial CXR more than 1.5cm changes in widest cardiac daim. indicated cardiomegaly.Normal Increase pul. blood flow(pulmonary plethora). Due to Lt.-Rt shunt decrease pul. blood flow(pulmonary oligemia). Ex. TOFPul. Venous hypertension .upper zone vessels equal or enlarge than lower zone vesselsPulmonary edema.5. Pul. arterial hypertension”Causes:Core pulomalePul. EmbloiMitral valve disease, or LT.-RT shunt.idiopathicFeatures:enlargement of pulmonary A.& hilar arteries
Pericarditis Cardiomyopathy Heart failure CXR PA view increase C/T ratio Lat. decrease in size of retrocardiac & retrosternal spaces , backward displacement of esophagus
Cardiac enlargement+/- selective chamber enlargement Increased pulmonary venous pressure ( increase vasculairty in upper lung zones) Pulmonary edema pleural effusion. usually bilateral RT. Larger than LT. but if unilateral its s almost always Rt.side.
Causes Mitral stenosis/ regurgitation LVF LA myxoma VSD PDA
>7 cm distance between left main stem bronchus and right lateral LA shadow
Doube right heart border
Increased convexity of posterio-superior cardiac margin Posterior displacement of left main bronchus Posterior displacement of barium filled esophagusTricuspid stenosis/ regurgitation ASD AF Ebstein anomaly Pulmonary atresia
Increase in curvature of RT heart border. Prominent round superior border at junction with SVC >5.5 cm from midline to most lateral RA margin >2.5 cm from right vertebral marginPressure overload: Hypertension , AS Volume overload: VSD, AR, MR Aneurysm Cardiomyopathy
Enlarges in post, inferior and leftward direction Increased Cardiothoracic ratio Larger radius of curvature of left heart border Downturned cardiac apex Depression of left hemidiaphragmIncreased convexity of posteroinferior cardiac margin Hofman rigler rule: posterior cardiac margin projects >1.8 cm post to IVC measured at a point 2cm above intersection of IVC with right hemidiaphragm
PV stenosis Cor pulmonale ASD Tricuspid regurgitation Secondary to LVF
Only extreme dilatation causes signs on frontal view Straightening/ convexity of left upper cardiac contour Upturned cardiac apex Left upper cardiac margin parallels left main stem bronchus as a long convex curvature Large appearance of MPA Occurs higher on the left heart border between left ventricular contour and pulmonary outflow tract
Prominent convexity of ant heart border >1/3 distance from anterior cardiophrenic sulcus to sternal angle Increased size prominent in retrosternal area
Mitral valve disease Mitral stenosis Radiological sign: 1.Lt atrial enlargement with normal cardiac size 2. Mitral valve calcification 3.Increase pulmonary venous pressure. 4.Pulmonary edema.
Lt atrial &Lt.ventricular enlargement (increase cardiac size with LT ventricular configuration.. Pulmonary edema Increase pulmonary venous pressure.
Aortic stenosis: valve calcification Poststenotic dilation in ascending aorta LT ventricular enlargement Pul. venous hypertension. 3&4 are late features
Dilated ascending aorta. Lt. ventricular enlargement (early)
Stenosis& regurgitation: Enlargment of Rt.atruim & SVC.Pulmonary stenosis Normal cardiac size Enlargement of main pul. A. Coarctaion of aorta: 1.Indentaion on aortic arch. 2.Dilation above coarctation due to Lt.subclavian A. enlargement 3.Dilation below coarctation due to poststenotic dilation of aorta. 4. Cardiac enlargmnt 50. Rib indentation : in long standing cases small cortical rib indentation due to enlargements of intercostal vessels.
Tetralogy of fallot : VSD Overriding of aorta Rt ventricular outflow obstruction RV hypertrophy. Radiological features: Normal CXR 50%. Boot shape heart Oligaemic lung Rt side aorta in 25%.
Cardiac enlargement. Enlargement of Lt. main PA. pulmonary plethora.
Lt atrial myxoma Most common benign cardiac tumor .it may arise from intra-atrial septum or cardiac wal Radiological features: Best seen by cardiac MRI or echocradic study. Most patient have normal CXR. It may pedineculates floating within atrium to mitral valve causing MV dysfunction mimic MS or MR.
pericardial effusion Marked increase in cardiac diam. With no specific chamber enlargements. Calcifications seen up o 50% of constrictive pericarditis. By echo study : As little as 25-50cc can be seen as echo-free fluid echogenisty between cardiac wall &pericarduim.