Semiology of the Heart in the 21 st century
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1 Semiology of the Heart in the 21 st century Workshop Rodrigo Salgado Dept of Radiology Antwerp University Hospital - Belgium
2 Question The cardiothoracic index a. Is something I always mention, because it s important b. Is something I always mention, because the clinician expects it c. Is something I ve never heard of, tell me now! d. Is a crude way of assessing cardiac size Answer: d
3
4 Comparison XR/CT anatomy
5 Comparison XR/CT anatomy
6
7 Small heart vs Big heart
8 Case 2
9 Question The changes indicated by the arrow are a sign of a. Descending aorta tortuosity b. Left atrial dilatation c. Left ventricular dilatation d. A large pericardial effusion or mass Answer: B
10 Left atrial dilatation E.G.: Non-compaction cardiomyopathy
11 Left atrial dilatation Signs on chest XR Double density on the left side Convex left atrial appendage Spreading of the carina Displacement of the left main stem bronchus CT > 4 cm transverse diameter depending on subject
12 Enlarged left atrial appendage
13 Left heart dilatation Left atrial dilatation Mitral valve stenosis & regurgitation Left ventricular failure Atrial fibrillation Congenital etiology (VSD, PDA, )
14 Case 3
15 Question This is a clear case of a. Pericarditis b. Left & right atrial dilatation c. Right ventricular dilatation d. Acute pressure overload due to aortic stenosis Answer: B
16 Right heart and left atrium dilatation
17
18 Right heart dilatation Right atrial enlargement Significant displacement to the right of the spine Prominent convexity superiorly near the SVC junction On a lateral view, displacement behind the IVC mimicking left ventricular dilatation Right ventricular enlargement Uplifted apex Filling of the retrosternal space on a lateral view Posterior rotation of the heart
19 Right heart dilatation
20
21 Patient A Patient B
22 Question The following statement is correct a. Patient A has a calcified epicardial Ecchinococcus cyst b. Patient B has extensive mitral and aortic valvular calcifications A c. Patient A has an left apical ventricular aneurysm d. Patient B has and old calcified myocardial infarction Answer: C B
23 Left ventricular dilatation E.G.: Myocardial infarction Mostly occlusion of coronary artery Key imaging facts Rounding of the cardiac apex Enlargement of left ventricle to the left, inferior and posterior Large right atrial enlargment may mimick left ventricular enlargement Effects of changed wall kinetics: developing of aneurysm
24 Left ventricular dilatation: MI
25 Left ventricular dilatation: MI
26 Left ventricular dilatation: MI
27 Left ventricular dilatation: MI
28 Left ventricular dilatation: MI
29 Left ventricular dilatation: MI
30 Old pericarditis
31 Cardiac and pericardial calcifications Calcifications Marker for specific disease Aid for locating structures: valves, pericardium Etiology Mostly dystrophic Secondary to previous infectious or inflammatory process Rheumatic mitral stenosis, TB Degeneration of malformed structure Bicuspid aortic valve
32 Cardiac valvular calcifications Aortic valve calcifications
33 Cardiac valvular calcifications Annular mitral valve calcifications
34 Cardiac valvular calcific ations Annular mitral valve calcification
35
36 Last question
37 Question The favorite Belgian beer of yours truly is: a. Heineken b. Duvel c. Hoegaerden d. West-Malle Trappist Answer: B
38
39 Thank you!
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