Bronchogenic cyst

Cystic fibrosis
Normal CXR post heart and lung
transplant
Post transplant complications ,
bronchiolitis obliterance
Congenital diaphragmatic hernia
fluid in the bowel
Congenital diaphragmatic hernia
air in the bowel
Congenital diaphragmatic hernia
post op pneumothorax
Congenital Lobular Emphysema
c
y
s
t
i
Cystic Hygroma
HMD
Intestinal lobular emphysema
pneumothorax
Tension pneumothorax
Pneumonia
CROUP
Epiglottitis
Thymus on CXR
Thymus on CXR
Thymus on CXR
VSD
VSD
 VSD: Radiographic Findings
Conventional chest film findings are usually
evident only in patients with medium to large
sized defects
 pulmonary vascularity ( pulmonary plethora)
 pulmonary artery outflow tract
RV enlargement
Enlarged left atrium & posterior displacement
and elevation of left main stem bronchus.
Signs of pulmonary oedema (CHF)
ASD
 ASD: Radiographic Findings
CXR in infants is usually normal.
 pulmonary vascularity (pulmonary plethora) .
Prominent main pulmonary trunk.
RA & RV dilatation, apex turned upward,rotation
of mediastinal contour to the left.
Absent SVC contour, rotated over the spine.
No enlargement of LA, due to immediate
decompression of blood to RA during systole
and diastole.
Atrial Septal Defect (Eisenmenger situation)
Ventricular Septal Defect
(Eisenmenger situation)
 Eisenmenger Physiology
LT to RT shunt volume of blood in PA 
pressure  PA hypertrophy & endothelial
thickening  pulmonary hypertension
Pulmonary pressure >systemic pressure  RT
to LT shunt  cyanosis
“pruned” appearance of PBF on CXR:
dilated central arteries with diminutive peripheral
arteries
PDA
 Patent Ductus Arteriosus
Comprise 8-10% of CHD.
AO
There is systemic-pulmonary
shunt between the LVE RA
descending aorta and the
PDA
left pulmonary artery just
distal to the left subclavian LAE RV
artery

PV ↑ PA ↑
 PDA: Radiographic Findings
In neonates :
pulmonary plethora
left atrial enlargement
left ventricular enlargement
CHF
In older children:
pulmonary plethora
left atrial enlargement
left ventricular enlargement
Enlarged aortic knob is theoretically possible but seldom noted.
In reality no way to differentiate VDS & PDA on CXR in children
closed duct:
calcification
surgical coil or Rashkind umbrella
PDA Coil
PDA Rashkind umbrella
PAPVD
PAPVD
 Partial Anomalous Pulmonary
Venous Connection
Pulmonary vein drain to RA, SVC or IVC
Associated with ASD esp. sinus venosus type
CXR: of ASD
Sometimes,anomalous pulmonary vein drain down to
IVC below the diaphragm more commonly on the right
side  SCIMITAR SYNDROME
CXR: curved vessel in the right lower zone which is
widening as it approaches the right cardiophrenic angle,
frequently associated with hypoplasia of the right lung &
mediastinal shift of the heart to the right.
D-TGA
 Dextro- TGA
Atrioventricular concordance
ventriculoarterial discordance
incompatible with life unless there is ASD,
VSD or PDA

LA RA

LV RV

PA AO
 D-TGA: Radiographic Findings
Normal to increase pulmonary vascularity
Inapparent pulmonary artery segment
Right heart prominence
“Egg-on-side” or “ Apple on string”
appearance
Congenitally Corrected Transposition of
Great Vessels (L-TGA)
Atrioventricular discordance
ventriculoarterial discordance
The levo-transposition of great vessels
The patient is usually acyanotic

RA LA

LV RV

PA AO
Congenitally Corrected L-TGA
 L-TGA: Radiographic Findings
Findings are related to the severity of associated
intracardiac lesions:
VSD in 50% of cases
pulmonary stenosis in 50% of cases
single ventricle in 35% of cases
CXR:
often normal ,  or  pulmonary vascularity due to
associated intracardic lesions
abnormal fullness (bulge) along the left upper heart
border due to the ascending aorta and RV
If isolated lesion, the child lives normal life
TAPVD Type I
TAPVD
Type I
TAPVD Type I
 TAPVC: Radiographic Findings
Types I, II & IV:
pulmonary plethora
right heart enlargement
wide mediastinum“snow man”,“figure of 8” configuration
seen in type I
Type III :
normal size heart
pulmonary venous hypertension
If pulmonary venous obstruction happened  pulmonary oedema
If normal heart size + interstitial oedema think of infracardiac
TAPVC
TOF
 Tetralogy of Fallot
The most common cause of cyanotic CHD
beyond the neonatal period
Comprise 8-10% of CHD
Four Aspects:
Right ventricular out flow obstruction
pulmonary valve stenosis
infundibular narrowing
VSD
Aorta “overriding” the ventricular system
Right ventricular hypertrophy
 TOF: Radiographic Findings

Pulmonary plethora
right ventricular hypertrophy, upturned
cardiac apex, “ boot- shaped”
innapparent pulmonary artery segment
large aorta, right sided aortic arch in 25% of
cases
presence of collateral flow with a reticular
pattern in the upper medial lung field, seen
in TOF with pulmonary atresia
Ebstein’s Anomaly
 Ebstein’s Anomaly
< 1% of CHD
Downward displacement of the septal & occasionally the
posterior leaflets of the tricuspid valve  “ atrialization” of
the right ventricle
ASD always present with RT  LT shunt due to poorly
functioning RV
CXR: depends on the degree of dilatation of the right side
of the heart
“box-shaped heart” resembles pericardial effusion
normal or  pulmonary vascularity
Coarctation of Aorta: rib notching
Coarctation of Aorta :Fig of 3
sign
Coarctation
of aorta:
MRA
Coarctation of
aorta: MRA
 Congenital Aortic Stenosis
Bicuspid aortic valve
2% of population
If critical stenosis  neonatal CHF, cadiomegaly
If mild stenosis 
normal pulmonary vascularity
normal size heart with left ventricular contour
post-stenotic dilatation of ascending aorta
calcification in adult patient with AV stenosis
 Coarctation of the Aorta
Occurs just distal to the origin of left subclavian
artery
Comprises 5% of all CHD
Associated with bicuspid aortic valve (80%),
PDA (60%) & VSD (30%)
Other associations: tracheo-oesophageal fistula
& circle of Willis aneurysms
 Coarctation of the Aorta:
Radiographic Findings
Inferior rib notching (ribs 3-8) due to hypertrophied
intercostal arteries as collaterals ,rare in a child before 8-
12 years
Normal pulmonary vascularity
Normal size heart with left ventricular contour
Abnormal aortic arch- “figure 3 sign”due to prominent
ascending and descending aorta (post stenotic dilatation)
Reverse “3 sign” with barium in esophagus
MRI can illustrate the exact site & length of the coarctation
Aortic Stenosis
Pulmonary Valve Stenosis
 Pulmonary Stenosis
The most common acyanotic lesion, found either
isolated or incombination with other cardiac
lesions
CXR:
post stenotic dilatation of the main PA segment & left
main PA due to “jet” effect of ejecting blood
normal heart size, right ventricular hypertrophy with
upturned cardiac apex
normal pulmonary vascularity
RT sided aortic arch
 Heterotaxy
Definitions:
situs-
visceroatrial (position of the atria & abdominal viscera)
bronchial (position of “RT” & “LT” bronchus)
solitus- normal or usual
inversus- mirror image of a group of structures with retention of
the same anterior/ posterior relationships
transposition- reversal of anterior/ posterior relationships
levocardia- left sided cardiac apex
dextrocardia- right sided cardiac apex
mesocardia- midline or central cardiac apex
ectopia cordis- external cardiac structures including the apex
 Heterotaxy
viscero-atrial situs
Situs solitus
situs inversus
situs indeterminatus or ambiguous
Bronchial situs
Eparterial bronchus
Hyparterial bronchus
Visceral - Atrial Situs
SITUS SOLITUS SITUS INVERSUS
NORMAL A

RV RV
RA LV LV RA
LA LA

R L

LV LV
RV LA LA RV
RA RA

DEXROVERSION P LEVOVERSION
S.SOLITUS S.INVERSUS
 Visceral - Atrial Situs
Situs solitus (normal)
morphologic RA on the right
morphologic LA on the left
spleen & stomach on the left
major hepatic lobe on the right
usually a left aortic apex
usually a left cardiac apex
normal A/P relationships
normal RT/LT relationships
1% incidence of CHD
Situs inversus
morphologic RA on the left
morphologic LA on the right
spleen & stomach on the right
major hepatic lobe on the left
usually a right aortic apex
usually a right cardiac apex
normal A/P relationships
reversed RT/LT relationships
3-5% incidence of CHD
Kartagener syndrome
Situs inversus
Situs inversus
 Visceral - Atrial Situs
Dextroversion of s. solitus
morphologic RA on the right
morphologic LA on the left
ventricular concordance
RV & RA- posterior chambers
normal RT/LT, reversed A/P
spleen & stomach on the left
major hepatic lobe on the right
usually left sided aortic arch
usually right sided apex
cardiac apex formed by- RV
95% incidence of CHD
Levoversion of s. inversus
morphologic RA on the left
morphologic LA on the right
ventricular concordance
RV & RA- posterior chambers
reversed RT/LT, reversed A/P
spleen & stomach on the right
major hepatic lobe on the left
usually right sided aortic arch
usually left sided apex
cardiac apex formed by- RV
100% incidence of CHD
Dextroversion of s. solitus
 Dextrocardia of situs solitus
The position of cardiac mass/apex is NOT
directly related to visceroatrial situs and
may not correspond with it. The apex can
occasionally be directed towards the right
side even with normal visceroatrial situs,
this is described as isolated dextrocardia
or dextrorotation of heart
 Visceral - Atrial Situs
Dextroversion of s. solitus
morphologic RA on the right
morphologic LA on the left
ventricular concordance
RV & RA- posterior chambers
normal RT/LT, reversed A/P
spleen & stomach on the left
major hepatic lobe on the right
usually left sided aortic arch
usually right sided apex
cardiac apex formed by- RV
95% incidence of CHD
Levoversion of s. inversus
morphologic RA on the left
morphologic LA on the right
ventricular concordance
RV & RA- posterior chambers
reversed RT/LT, reversed A/P
spleen & stomach on the right
major hepatic lobe on the left
usually right sided aortic arch
usually left sided apex
cardiac apex formed by- RV
100% incidence of CHD
Levoversion of s. inversus
 Levocardia of situs inversus
situs inversus with the cardiac apex lying
on the left called isolated levoctardia, i.e.
the reverse of isolated dextricardia in situs
solitus
 Visceral - Atrial Situs
Situs Ambiguous
normal visceral & atrial relationships allowing
each side of the body to be unique is ABSENT
atrial identification & differentiation is NOT
possible
consider whenever cardiac apex & stomach are
located on opposite sites
asplenia & polysplenia
 Situs Ambiguous
Asplenia
bilateral RT sidedness
single atrium with two RT
atrial appendages
bilateral eparterial bronchi
& trilobed lungs
hepatic symmetry
absent spleen
IVC connection to common
atrium
bilateral SVC
Polysplenia
bilateral LT sidedness
single atrium with two LT
atrial appendages
bilateral hyparterial bronchi
& bilobed lungs
hepatic symmetry
multiple spleens
high incidence of azygous
continuation of IVC
bilateral SVC
Situs Ambiguous
Pericardial Effusion
 Pericardial Effusion
 On CT: may identify the etiology e.g. mediastinal
malignancy
 On MRI: accurate for diagnosis and also images
chest and mediastinum
 Causes: infective (viral, bacterial, tuberculosis)
uremia, postmyocardial infarctions (Dressler’s
Syndrome) myxoedema, malignancy, bronchial and
mediastinal tumours with pericardial invasion,
collagen vascular disease (systemic lupus
arythematosus, rheumatoid arthritis.