Imaging of the Heart

Question 1

VD view

Answer 1

Ventrodorsal View
The dog is on its back
You can see both the right and left crus of the diaphragm and the cupula in the middle.

Question 2

DV View

Answer 2

Dorsoventral view
Dog is laying sternally on stomach
You can see only one cura of the diaphragm and the cupula

Question 3

Right lateral View

Answer 3

Look at the diaphragm. The right and left cura should be parallel with each other. The right curs is first. You will also see the caudal vena cava clearly going to the right crus. The cupula is at the bottom.

Question 4

Left Lateral View

Answer 4

Look at the diaphragm. The right and left crus are not parallel, they crisscross. The dark lucent area in between is the stomach. The caudal vena cava is not as clear on the left lateral view since the left curs is on top of the right curs. The cupula is at the bottom.

Question 5

Where will a lesion on the left lung be best seen?

Answer 5

On the right lateral view
the up lung will be better insufflated and provide better lesion contact

Question 6

Which lung lobe has a middle lobe?

Answer 6

The right lung lobe

Question 7

Mediastinum

Answer 7

Above the heart

Question 8

What are the 3 types of intra-thoracic lymph nodes?

Answer 8

Sternal, cranial mediastinal, and tracheobronchial lymph nodes

Question 9

What part of the heart is the right?

Answer 9

Cranial ventral part

Question 10

What part of the heart is the left?

Answer 10

Caudal half

Question 11

Describe the clock face analogy of the heart

Answer 11

11 - 1 = Ascending Aorta
1 - 2 = Main pulmonary artery
2 - 3 = Left auricle
3 - 5 = Left ventricle
5 - 9 = Right ventricle
9 - 11 = Right atrium

Question 12

What is included in the right chambers of the heart?

Question 13

What is included in the left chambers of the heart?

Question 14

When does the right atrium and left auricle form an edge or margin?

Answer 14

On DV/VD

Question 15

How does expiration affect the radiographic appearance of the heart?

Answer 15

Makes it look bigger because there is decreased overall volume of the thorax

Question 16

What are some things to consider when deciding if a heart looks normal or not?

Answer 16

Obesity, breed conformation, inspiration and expiration, and positioning

Question 17

How will the heart look on deep-chested breeds?

Answer 17

Narrow heart that looks compressed and upright. It will have minimal sternal contact.

Question 18

How will the heart look on brachycephalic breeds?

Answer 18

Heart will appear wider and have increased sternal contact since they are deep chested

Question 19

What does mediastinal fat look like on radiograph?

Answer 19

Increased opacity all around the heart with blurred margins

Question 20

What can lift a heart from the sternum?

Answer 20

Fat or atelectasis

Question 21

What are patterns of heart enlargement?

Answer 21

Left heart enlargement, right heart enlargement, generalized cardiomegaly, pulmonary trunk enlargement, and descending aorta enlargement

Question 22

What is the most common heart enlargement pattern?

Answer 22

Left heart enlargement

Question 23

What is the goal standard for mild cardiomegaly?

Answer 23

Echo

Question 24

What will a left atrial heart enlargement look like on a lateral view?

Answer 24

Enlargement of dorsocaudal border (bulge) = left atrial, dorsal deviation (elevation) of entire trachea (parallel to spine), increased “verticality” of caudal margin of heart (tall heart), and caudal bronchi separation (left atrium bulges up between them)

Question 25

What is the corina?

Answer 25

Where trachea bifurcates

Question 26

What will left atrial enlargement look like on a VD/DV view?

Answer 26

Left atrium may produce increased opacity at base of the heart, with lateral deviation of caudal bronchi (bowlegged cowboy sign). Left auricle may bulge at 2-3 oclock as well as left atrial enlargement. Has to be a left atrial enlargement if we see a left auricle enlargement. LA doesn't form margin, sits on top of the heart.

Question 27

When do you typically see left ventricular enlargement?

Answer 27

Seen with left atrial enlargement

Question 28

What are examples of left heart diseases?

Answer 28

Mitral valve disease, puppy PDA, SAS, VSD

Question 29

What are examples of right heart diseases?

Answer 29

Tricuspid dysplasia, heartworm disease, Pulmonic stenosis, Teratology of Flow,

Question 30

What is puppy PDA?

Answer 30

Patent Ductus arteriosus - ductus arteriosus fails to close and cause a huge volume overload on the left heart and get a very tall heart and big left atrium. You will see a bulge in descending aorta. Most of the most common heart defects in dogs.

Question 31

What will right heart enlargement look like on a lateral view?

Answer 31

Increased width of heart, increased sternal contact, elevation of trachea if severe, corina & trachea will be going downhill (no LA enlargement), reversed D (left heart is straight but right side bulges out), decreased distance from right heart border to right chest wall, pulmonary trunk (MPA) can be enlarged (bulge at 1-2 oclock)

Question 32

True or False: PA/PT enlargement is rarely seen in cats

Answer 32

True

Question 33

What is not a common heart enlargement pattern?

Answer 33

Aortic enlargement (descending aorta). Not usually visible on lateral view, bulging of descending aorta on DV/VD view

Question 34

Generalized cardiomegaly

Answer 34

Basketball heart (uniform), globoid, "pumpkin" shaped heart (if the pericardial effusion is severe)

Question 35

What are the causes of generalized cardiomegaly?

Answer 35

Pericardial effusion (most common) Right and left heart enlargement Pericardial-peritoneal diaphragmatic hernia (congenital defect)

Question 36

What is pericardial effusion?

Answer 36

Fluid between heart and pericardial

Question 37

What is a pericardial-peritoneal diaphragmatic hernia?

Answer 37

Intestines in the heart

Question 38

Are feline or dog heart enlargement patterns more subtle?

Answer 38

Feline

Question 39

Describe left heart enlargement in the feline on lateral view

Answer 39

Increased length of heart (tall heart) Slight bulging or bending of cardiac silhouette Mainly due to left atrial enlargement Left ventricle thickened at the expense of lumen Trachea elevated dorsally

Question 40

Describe left heart enlargement in feline on VD/DV view

Answer 40

LV hypertrophy: maintains normal apex Widening of the cranial heart base due to mainly LA and LAaur enlargement "Valentine shaped heart"

Question 41

What is the Vertebral Heart Score (VHS) and how do you use it?

Answer 41

Used to measure if heart is too big or too small How to measure: 1) Long axis of heart is measured from ventral border of left stem bronchus to most ventral portion of cardiac apex. 2) Maximum short axis of heart measured perpendicular to long axis 3) Lengths are compared to thoracic vertebrae starting at cranial T4 and extending caudally (going backwards) 4) Count the # of vertebral bodies from both lines and add the lines together to get the VHS on lateral radiograph

Question 42

What is the normal VHS score of dogs?

Answer 42

9.7 +/- 0.5 vertebral body lengths

Question 43

What is the normal VHS score of cats?

Answer 43

7.5 +/- 0.3 vertebral body lengths

Question 44

What are the flaws of VHS?

Answer 44

Varies with breed (in dog) Doesn't specify which chamber enlarged Considerable overlap between normal and abnormal dogs