CARDIOVASCULAR IMAGING

LEVEL V MBCHB BY DR ONYAMBU LECTURER DDIRM

Objectives
Understand the different modalities for imaging the cardiovascular system Know the optimal modality for each clinical indication

IMAGING MODALITIES
Plain CXR-PA,LAT Echocardiography Isotope scanning Cardiac catheterisation Angiocardiography CT MRI

PLAIN X-RAYS

Plain radiographs are important as the first imaging investigation in cases of heart disease. It gives vital information concerning:
Size of the heart Enlargement of individual chambers Pulmonary vasculature Condition of the lung fields Presence or absence of pleural effusion

SIZE OF THE HEART

Measured by the cardio-thoracic ratio (CTR) The maximum transverse diameter of the heart is compared to the maximum transverse diameter of the chest. In normal adults this is <_ 50% In children it is <_ 60%

THE SHAPE OF THE HEART

The cardiac contour has characteristic appearance in specific conditions depending on the chambers mainly enlarged. LV enlargement is seen in HTN, and aortic valve disease

The apex enlarges downward and to the left

LV ENLARGEMENT

THE LEFT ATRIUM

LA enlargement is seen in mitral valve disease,

Enlarges backwards and to the right Double density of the heart Projects backwards and slightly upwards in the lateral film . Makes an impression on the barium filled oesophagus.

MR

Severe MR disease .Left atrial appendage is large , producing a convex bulge (arrow). The heart is considerably enlarged

VSD

RIGHT VENTRICULAR ENLARGEMENT

May also be seen in mitral disease due to increased pulmonary resistance secondary to pulmonary congestion Also seen in congenital cardiac lesions associated with pulmonary stenosis or LR shunts. Pulmonary disease with chronic airway obstruction

RV
Lifting and rounding of the apex Filling of the retrosternal airspace

LUNG FIELDS
CONGESTION-due to pulmonary venous hypertension following left heart lesions resulting in back pressure on the lung. Causes include; LV failure and mitral valve disease. CXR

Diversion of blood from the lower to the upper zones of the lung in an erect PA film of the chest

Cont
Pulmonary oedema with interstitial or alveolar involvement Septal lines- Kelly A,B and C Lamellar effusions Alveolar oedema is often perihilar with blurring of the central lung areas (bats wing appearance) Pleural effusions may be seen.

PULMONARY PLETHORA

Seen in conditions of high pulmonary flow mainly due to congenital L-R shunts. Both arteries and veins become prominent with end on vessels close to the hilum being particularly well seen, and distal vessels extending to the lung periphery PAH (pulmonary arterial hypertension) may develop in long standing ASD, increased resistance caused by severe pulmonary venous HTN

Cont..
PAH may develop acutely following massive pulmonary embolus or from chronic multiple pulmonary emboli. PAH also occurs in chronic pulmonary disease with chronic airways obstruction

X-Ray Findings-ASD

Enlarged pulmonary vessels Normal-sized left atrium Normal to small aorta.

PULMONARY OLIGAEMIA
Occurs when there is obstruction to the pulmonary outflow at or below the pulmonary valves. It may be seen in R-L shunt as in tetralogy of Fallot

PERICARDIAL EFFUSION
May be classified as 1.Inflammatory -TB -Supprative -Rheumatic -Viral 2.Non-inflammatory -heart failure -myocardial infarction -Uraemia -Haemopericardium 3.Malignant

Pericardial effusion
The radiological diagnosis can be difficult unless the fluid is more than 200 mls. R.F

Enlarged globular heart Masking of the hilar U/S is diagnostic CT or MRI may show the effusion

CXR-pericardial effusion

CCF

Kerley A & B lines

Myocardial Ischaemia

IMAGING FEATURES

Plain radiographs:- normal Myocardial perfusion studies:scintiscans of the heart are taken at rest and after exercise. Thallium 201 is taken up by viable perfused myocardium. Thallium 201 is injected during exercise test with immediate exercise images and perfusion images 3 hrs later, after resting

Myocardial perfusion study. Thallium scan showing reversible anterior myocardium ischaemia. Images are xsectional tomograms of the left ventricle.