Cardiovascular Imaging Cardiovascular Imaging

Methods of examination Cardiovascular Imaging

Radiology • Conventional radiography (Chest X-ray) – PA – LL – OBLIC • RAOP • LAOP • Fluoroscopy

Cardiovascular Imaging

Radiology • Contrast examination – Ventriculography – Angiography • Aortography • Angiocoronarography • Arteriography • Flebography

Cardiovascular Imaging

Radiology • Computed Tomography (CT) RADIOLOGY CT-3D Cardiovascular Imaging Nuclear Medicine

• Nuclear angiocardiography • Myocardial perfusion scintigraphy • PET Cardiovascular Imaging

Ultrasonography • M-mode • B-mode • Doppler Cardiovascular Imaging Ultrasonography Cardiovascular Imaging Ultrasonography interventricular septum defect Cardiovascular Imaging MRI Cardiovascular Imaging MRI MRI Cardiovascular Imaging

Radiological anatomy Cardiovascular Imaging • PA projection – Left side: • Convexities – I. Aortic Knob – II. Main Pulmonary Artery – III. Left Atrial Auricula – IV. Left Ventricle – Right side: • Convexities – I. Ascending Aorta, Vena Cava Superior – II. Right Atrium Cardiovascular Imaging

Aortic Knob Ascending Aorta, Vena Cava Superior Main Pulmonary Artery

Left Atrial Auricula

Right Atrium Left Ventricle Topometry = Cardiothoracic ratio CTR= (A+B) / C

The cardiothoracic ratio (CTR) shown in figure is the transverse cardiac diameter (the horizontal distance between the most rightward and leftward borders of the seen on a PA chest radiograph = maximum extension of the heart to the left and right of the midline respectively) divided by the transverse chest diameter (measured from the inner rib margin at the widest point above the costophrenic angles on a PA chest film). If the cardiac thoracic ratio is greater than 50%, pathology is suspected. Cardiovascular Imaging

• RAO projection

– Anterior (retrosternal) • Superior – Ascending Aorta • Middle – Pulmonary Trunk • Inferior – Left Ventricle

– Posterior (retrocardiac) • Superior – Vascular Structures (descending aorta) • Inferior – Left Atrium and Right Atrium Cardiovascular Imaging

• LAO projection

– Anterior (retrosternal) • Superior – Ascending Aorta • Middle – Right Atrium • Inferior – Right Ventricle

– Posterior (retrocardiac) • Superior – Pulmonary Artery • Middle – Left Atrium • Inferior – Left Ventricle

Cardiovascular Imaging

Abnormal Radiological Findings Cardiovascular Imaging

• Specific chamber enlargement

– Left Atrium: prominence on the right side • RAO+Barium Esophagogram

– Left Ventricle: prominence on the left side • PA, LAO

– Right Atrium: prominence on the right side • PA

– Right Ventricle: rotation to the left • LAO

1. different degree of enlargement of the heart to the left, 2. cardiac bay ,,golf’’ disappears 3. cardiovascular angle displaced cranially 4. poorly pronounced or absent aortic knob Cardiovascular Imaging • Mitral configuration – Mitral Stenosis – Mitral Regurgitation – interventricular septum defect – Arterial canal persistence – Pulmonary artery stenosis – Pulmonary heart Cardiovascular Imaging • Mitral configuration

1. cardiac enlargement to the left, 2. pronounced cardiac golf, 3. different variants of change of the thoracic aorta, 4. cardiovascular angle moved caudally Cardiovascular Imaging • Aortal configuration – Aortal Stenosis – Aortal Regurgitation – Aortal Coarctation – – Arterial Hypertension Cardiovascular Imaging • Aortal configuration

1. enlarged heart shadow in transverse diameter 2. cardiovascular angles moved cranially 3. reduced delineation of the convexities Cardiovascular Imaging • Trapezoid configuration – Tricuspidal Stenosis – Tricuspidal Regurgitation – Interatrial septal defect – Diffuse myocardial pathology – Pericardial effusion Cardiovascular Imaging • Pericardial effusion Cardiovascular Imaging • Calcified pericarditis Cardiovascular Imaging Cardiovascular Imaging

• Congenital Heart Disease (CHD) – (situs inversus) – Acyanotic (left to right shunt) • • Ventricular septal defect – Cyanotic (right to left shunt) • Ebstein’s anomaly (Tricuspidian defect, Small right ventricle, Septal atrial defect) • Tetralogy of Fallot • Trilogy of Fallot – Coarctation of the aorta Cardiovascular Imaging

– Tetralogy of Fallot • Interventricular septal defect • Infundibular pulmonary artery stenosis • Right aortic arch (over-riding of the aorta) • Right ventricular hypertrophy

– Trilogy of Fallot • Interatrial communication • Pulmonary artery stenosis • Right ventricular hypertrophy malformation complex with the presence of three signs : 1. narrowing the opening of the pulmonary artery 2. cleft of atrial sept 3. right ventricular hypertrophy

Cardiovascular Imaging

– Coarctation of the aorta Ao – aorta, LSCA - left subclavicular artery

Cardiovascular Imaging – Coarctation of the aorta MR-angiography Cardiovascular Imaging Assessment of pulmonary vascularity

Pulmonary circulation Cardiovascular Imaging

Assessment of pulmonary vascularity on the lung fields • Pulmonary oligemia • Pulmonary hyperemia (pleonemia, plethora) • Pulmonary venous post-capillary hypertension (stasis) • Pulmonary edema • Pulmonary pre-capillary arterial hypertension Hipovolemy

1. A pour pulmonary pattern 2. Major pulmonary transparency 3. Lung hila are structured and slim 4. The second border on left – pulmonary artery is normal or decreased or dilated (poststenotic dilation) Hipervolemy

1. An enhanced pulmonary pattern 2. Lung hila are dilated 3. Cardiac golf leveled

Pulmonary interstitial edema Pulmonary arterial hypertension

1. The pulmonary pattern is decreased at lateral regions of the lungs 2. Major or normal pulmonary transparency 3. Lung hila are dilated 4. The second convexity on left – pulmonary artery is dilated