Cardiac Radiography. Jared D. Christensen, M.D.

Transcription

1 Cardiac Radiography Jared D. Christensen, M.D.

2 Cardiac radiography Jared D. Christensen, M.D.

3 Overview Basic Concepts Technique Normal anatomy Cases

4 Technique

5 3 Standard Views Posterior-Anterior (PA) Anterior-Posterior (AP) Lateral

6 Magnification R L

7 PA AP

8 Cardiac Anatomy

9 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC L brachiocephalic v./ L subclavian a Aortic arch 7. Main pulmonary a. 8. L atrial appendage 9. L ventricle 3 4 9

10 23-year old male with acute chest pain

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12 Q Where is the abnormality? A B C D. It s normal

13 Q Where is the abnormality? A B C D. It s normal

14 Q Where is the abnormality? A B C D. It s normal

15 Q What is the most likely diagnosis? A. Mediastinal mass B. Aortic dissection C. Pulmonary embolism D. Lymphadenopathy

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18 Aortic Dissection - Marfan Syndrome

19 Chambers

20 Cardiac Chambers 1. L Atrium 2. R Atrium 3. L Ventricle 1 4. R Ventricle 2 3 4

21 Heart Size Cardiac Index: A B A B

22 Heart Size Cardiac Index: A B A Normal: 50% B

23 Heart Size Volume Dilation Pressure Hypertrophy

24 Left Atrium Big left atrial appendage Retrocardiac double density Elevated left mainstem bronchus

25 Left Atrium Big left atrial appendage Retrocardiac double density Elevated left mainstem bronchus

26 Left Atrium Big left atrial appendage Retrocardiac double density Elevated left mainstem bronchus

27 Left Atrium Big left atrial appendage Retrocardiac double density Elevated left mainstem bronchus

28 Left Atrium Big left atrial appendage Retrocardiac double density Elevated left mainstem bronchus

29 Left Ventricle Enlarged left heart border Apex moves down and leftward

30 Left Ventricle Enlarged left heart border Apex moves down and leftward

31 Left Ventricle Enlarged left heart border Apex moves down and leftward

32 Right Atrium Divide hemithorax into thirds Right heart border is > ⅓

33 Right Atrium Divide hemithorax into thirds Right heart border is > ⅓

34 Right Atrium Divide hemithorax into thirds Right heart border is > ⅓

35 Right Ventricle Elevated cardiac apex Boot-shaped heart

36 Right Ventricle Elevated cardiac apex Boot-shaped heart

37 Right Ventricle Elevated cardiac apex Boot-shaped heart

38 Valves

39 Valves Tricuspid Mitral Aortic Pulmonic P A T M

40 Valves P A T M

41 Valves P A T M

42 Valves P T A M T P A M

43 Q Which valve is calcified?

44 Q Which valve is calcified? A. Aortic B. Pulmonic C. Mitral D. Tricuspid

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46 Heart Size Volume Dilation Pressure Hypertrophy

47 Valve Disease Stenosis Valve doesn t fully open Normal directional flow Insufficiency Valve doesn t fully close Reversed directional flow

48 Mitral Insufficiency Left atrium dilates Left ventricle dilates (over time) Normal pulmonary vasculature

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50 Mitral Insufficiency - Acute MI

51 Mitral Stenosis Left atrial hypertrophy/dilation Dilated pulmonary veins, then arteries Dilated right ventricle

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53 Mitral Stenosis

54 Aortic Insufficiency Left ventricle dilates Aorta may eventually dilate due to increased LV volumes

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56 Aortic Insufficiency

57 Aortic Stenosis Left ventricle hypertrophy/dilation Post-stenotic dilation of ascending aorta Pulmonary vessels are normal

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59 Aortic Stenosis (& Insufficiency)

60 Pulmonic Stenosis Right ventricle hypertrophy/dilation Post-stenotic dilation of pulmonary artery

61 Pulmonic Stenosis

62 Pericardium

63 Pericardium Anatomy: Visceral Space Parietal

64 6 weeks ago

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67 Pericardial Effusion

68 Vasculature

69 Vasculature Thoracic Aorta Pulmonary Arteries Pulmonary Veins

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71 2 days later

72 4 days later

73 Pulmonary Edema 4 days later

74 Interstitial Kerley B Lines

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76 Interstitial Alveolar

77 Cases

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79 1

80 Q What surgery has this patient had?

81 Q What surgery has this patient had? A. AVR B. Cardiac Txp C. CABG D. Lung Txp

82 Q What surgery has this patient had? A. AVR B. Cardiac Txp C. CABG D. Lung Txp

83 Q What surgery has this patient had? A. AVR B. Cardiac Txp C. CABG D. Lung Txp

84 Q Which tube/line is malpositioned? A D B C

85 Q Which tube/line is malpositioned? A D B C

86 Q Which tube/line is malpositioned? A D B C

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88 R Mainstem Intubation

89 R Mainstem Intubation

90 52-year-old male with chest pain and dyspnea.

91 2 52-year-old male with chest pain and dyspnea.

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93

94 Q Which chamber is abnormal?

95 Q Which chamber is abnormal? A. Left atrium B. Left ventricle C. Right atrium D. Right ventricle

96 Q Which chamber is abnormal?

97 Q Which chamber is abnormal? A. Left atrium B. Left ventricle C. Right atrium D. Right ventricle

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100 Left Ventricle Aneurysm

101 3 54-year old male with chest pain and dyspnea

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105 Q Which is the next most appropriate step in management?

106 Q Which is the next most appropriate step in management? A. Biopsy B. PET-CT C. CTA D. Surgical resection

107 Q Which is the next most appropriate step in management? A. Biopsy B. PET-CT C. CTA D. Surgical resection

108 Q Which is the next most appropriate step in management? A. Biopsy B. PET-CT C. CTA D. Surgical resection

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110 Aortic Arch Pseudoaneurysm

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115 Conclusions

116 Conclusions Learn what is normal Be systematic in your interpretation Contours, Chambers, Valves Physiology predicts pathology

117 Jared D. Christensen, M.D.

118 Cardiac radiography Jared D. Christensen, M.D.