B P3 C17 Chest Radiography in Cardiovascular Disease Flashcards
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Normal CXR PA and Lateral Views
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Ectatic ascending aorta (arrow) in a patient with aortic stenosis.
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PA and lateral chest x-ray in a patient with bioprosthetic aortic and mitral valves.
A, PA view reveals mitral valve ring and linear appearance of aortic valve ring that is in center of heart. The *mitral valve is located inferior to the aortic valve.**
B, Lateral view shows typical magnification of the right hemithorax and right ribs compared with the left hemithorax and left ribs. Mitral valve annulus is posterior to the aortic valve.
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Large pericardial effusion
The PA view reveals marked enlargement of heart with a hot water bottle shape. This can also have shape of an Erlenmeyer flask.
The lateral view reveals the normal size heart (arrows) inside the pericardial effusion.
Separation of epicardial from pericardial fat may be most apparent anteriorly.
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Aortic calcification
This is best seen on the PA view with long summation shadow-gram of aortic arch (large arrow). The PA view also shows calcification of tracheobronchial tree (small arrows), which is occasionally encountered in patients receiving warfarin.
The lateral view reveals extensive calcification of aorta as well as origins of great vessels and coronary arteries.
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Mitral annular calcification
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Calcified left ventricular p rysm (arrows).
The lateral view reveals posterior extension of the pseudoaneurysm.
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Constrictive pericarditis
The PA view reveals pericardial calcification extending across expected cardiac chamber boundaries and extending through the atrial-ventricular groove, resulting in severe constrictive pericarditis, while the lateral view shows extensive anterior, apical, and inferior calcification.
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Congestive heart failure
PA chest radiograph in a patient with congestive heart failure. There is enlargement of the left ventricle, left atrium, and main pulmonary artery, with pulmonary venous congestion.
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Left ventricular dilation and pulmonary edema
PA view shows venous cephalization, blurring of pulmonary vascular margins, and fissures and Kerley B lines. Lateral view shows pleural effusions.
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Idiopathic pulmonary hypertension
PA chest radiograph in a patient with idiopathic pulmonary hypertension. Idiopathic pulmonary hypertension causes marked enlargement of main pulmonary artery. Central pulmonary artery branches are enlarged with peripheral pruning. Extremely large central artery branch pruning may result in normalappearing peripheral branches despite marked decrease in size.
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Congenital heart disease with pulmonary arterial hypertension
The calcified pulmonary artery (arrows) indicates that it has carried systemic pressure. The patient is now presenting with Eisenmenger’s physiology and mild interstitial pulmonary edema. Note Kerley B lines in the base of the right lung.
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Truncus arteriosus
There is dilation of the main pulmonary artery, which is calcified (arrows) as a marker of chronic pulmonary arterial hypertension.
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Congenital pulmonic stenosis
A, PA radiograph demonstrates marked enlargement of the main pulmonary artery (MPA) (long white arrow), such that it is larger the aorta (short white arrow). Note that the right pulmonary artery and its branches are normal sized, and the enlarged left pulmonary artery (LPA) is hidden behind the dilated MPA.
B, On the lateral view the retrosternal space is filled by the enlarged right ventricle and the dilated MPA, which causes a masslike density with an upward convexity (long white arrow). Note dilated LPA (long black arrow) relative to the aorta (short white arrow)
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Ebstein anomaly
A, PA radiograph shows enlargement of the cardiac silhouette. The marked convexity of the right cardiac border is caused by the extremely dilated right atrium. The right ventricle is also much enlarged, as evidenced by the left lateral displacement of the right location of the tip of the ventricular lead of the cardiac pacemaker, which is located in the right ventricle.
B, Lateral view reveals the long length of contact of the anterior cardiac border with the sternum, indicative of overall RV enlargement.
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Coronary artery stents
Frontal (A) and lateral (B) views of the chest show coronary artery stents in a long length of the left anterior descending artery (LAD) (short arrows) and in the right coronary artery (RCA) (long arrows).
On the frontal view the RCA is difficult to visualize because it projects over the spine.
On the lateral view the courses of the LAD and RCA cross, such that the LAD extends more anteriorly toward the cardiac apex.
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True left ventricular aneurysm with myocardial calcification
Contrast-enhanced axial CT image demonstrates the true aneurysm of the left ventricle apex (arrow) caused by a previous infarct. Its wall is calcified, with a thin margin of hypoattenuating thrombus along the luminal surface (black arrow).
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Coronary artery bypass graft (CABG) aneurysm
A, Coned-down frontal view shows an abnormal budge along the upper margin of the cardiac border (long arrow) caused by an aneurysm of the saphenous vein CABG bypassing the right coronary artery. Surgical clips show the course of the left internal mammary artery CABG (short arrows) toward the left anterior descending coronary artery.
B, Coned-down contrast-enhanced axial CT image demonstrates that this aneurysm (arrow) causes mass effect on the right atrium and right ventricle and contains an eccentric filling defect with a large amount of intraluminal thrombus.
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“Water bottle” sign of pericardial effusion.
PA chest radiograph shows an extremely large cardiac silhouette, extending with the cardiac margins beginning higher than normal at the hilar level.
Contrast-enhanced CT axial image of the heart acquired at the time of the more recent radiograph shows a large pericardial effusion.
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Calcific pericarditis
A, Coned-down PA chest radiograph shows a nodular band of calcification (black arrows) projecting over the heart along the expected location of the left atrioventricular (AV) groove (short black arrows). There is also linear calcification along the inferior margin of the heart (long black arrows). Note the double density sign indicating left atrial dilation (white arrow).
B, Lateral view shows a band of extensive calcification projecting over the heart, again in the AV groove (black arrowheads) and also around the apex and anterior and inferior walls of the right ventricle (black arrows).
C, CT image depicts the extensive pericardial calcification.
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Pneumopericardium
A, PA chest radiograph shows lucent bands of air outlining the right and left cardiac borders. A radiodense band outlining the pneumopericardium represents the thickening visceral pericardium (arrows).
B, CT image obtained the same day demonstrates the small pneumopericardium, which developed after endoscopic balloon dilation of a distal esophageal stricture with a small fistula to the pericardium.
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Coarctation of the aorta
A, Coned-down frontal chest radiograph demonstrates inferior rib notching in patient with severe coarctation of the aorta (arrows). Note straightening of a mild outward curvature above the aortic knob caused by the left subclavian artery as it takes a relatively more vertical course above the coarctation site. This bulge with the aortic knob created the “figure of 3 sign” of coarctation.
B, Thick, maximum intensity projection image of magnetic resonance angiography of the aorta shows the coarctation site at the aortic isthmus (arrow), with extensive intercostal and internal mammary arterial collaterals, which are dilated and tortuous.
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Double aortic arch
Coned-down PA chest radiograph shows right paratracheal budge representing the larger and higher right aortic arch (long white arrow), relative to the smaller and more inferiorly located left arch (short white arrow). Note that the trachea is deviated to the left by the right arch (black arrow).
