Radiologic Diagnosis in Common

Diseases of Cardio-Vascular System

Department of Radiology of the

1st Affiliated Hospital of
Zhengzhou University

Ma nan( 马南 )
 Acquied heart disease
♦ 1.Valve heart disease
– A.mitral stenosis
– B.mitral regurgitation
– C.aortic stenosis
– D.aortic regurgitation
♦ 2.pulmonary heart disease
♦ 3.Hypertension heart disease
♦ 4.pericarditis
– (pericardial effusion,constrictive pericarditis)
 Congenital heart disease
♦ 1.no cyanose
– ASD(atrial septal defect)
– VSD(ventricular septal defect)
– PDA(patent ductus arteriosus)
♦ 2. Cyanose
– Fallot’s tetralogy
– transposition of great arteries
– total anomalous pulmonary venous drainage
Mitral valve disease
 Mitral valve disease

• Rheumatic heart disease results in chronic

rheumatic valve disease , namely valve
inflamation .
• Mitral valve is the commonest involved ,
followed by aortic valve and tricuspid valve .
 Pathology of Mitral stenosis

♦ Mitral valve inflammation

♦ →valve thickening , adhesion, coalesce,
shortening, and calcification
♦ → valve stenosis. It cause changes of
hemodynamics as follow:
 hemodynamics of Mitral stenosis

♦ 1) mitral stenosis
– →disturbance of blood flow from L.A to L.V
– →increase of pressure in L.A
– →L.A enlargement
– →L.A hypertension reverses pul. Veins
– →pul. Venous hypertention
– →pul. Capillaries hypertension
– →pul. Arterial hypertention
– →right v. Enlargement.
 hemodynamics of Mitral stenosis

♦ 2) Mitral stenosis
– → decreased blood flow in L.V
– → L.V atrophy
– → decreased blood in aorta
– → aortic knuckle small.
♦ 3)Mitral stenosis
– → pul. Venous hypertention
– → pul. edama→red cell in alveolar
– → swallowed by rhagiocrine cell
– → hemosiderosis.
 X-ray features of Mitral stenosis
1. changes of heart:
♦ 1). L.A enlargement . the
most obvious and
important sign .
– P-A view :
• a double density .
• double contour beyond the
R.A
• L.A appendage forms the
3 rd arch .
– RAO : displancement of
esophagus backward.
– LAO : L.A pushes left
main bronchus upward.
 X-ray features of Mitral stenosis
1. changes of heart:
♦ 2). R.V enlargement . it is the result of pul. arterial hypertension .
– P-A :
• The main stem of pul. artery segment convex .
• The point of opposite pulsation is downwards
– RAO: infundibulum is prominent .
– LAO: retrosternal space becomes narrow.
 X-ray features of Mitral stenosis
1. changes of heart:

♦ 3). L.V atrophy .

– it is the result of decrease of blood flow into L.V.
– L.V becomes strainght and short .
♦ 4). calcification in the valve .
 X-ray features of Mitral stenosis
2. changes of large vessels :
♦ 1). Aortic knuckle appears small .
– because of decreased blood flow in the L.V and aorta.
♦ 2). pul. artery segment bulge.
 X-ray features of Mitral stenosis
3. changes of lungs:
♦ 1). Pul. venous hypertention:
– a. upper zone vessel dilatation.
– b. hilum haziness and enlargement.
– c. lung markings hazy out-line.
♦ 2).interstitial edema:
– kerley B lines (horizontal lines seen in the
costo-phrenic angle , 2-3 cm long , 1-3 mm
width)
 X-ray features of Mitral stenosis
3. changes of lungs:
♦ 3).pul. hemosiderosis:
– it is the result of pul. venous
hypertension and it comes heart failure
cell.
– It shows multiple miliary opacities
 Mitral stenosis and regurgitation

♦ Characteristic:
– 1. L.A enlargement , pul. venous hypertention
and pul. arterial hypertention are more obvious
than single mitral stenosis.
– 2. L.V enlargement.
Pulmonary heart disease
 Pulmonary heart disease

♦ It is the result of pul. arterial hypertention secondary

to diseases of the lungs.
♦ Cause : chronic bronchitis, emphysema,
bronchiectasis, T.b, generalized pleural thinkening,
et ,al.
Pulmonary heart disease

♦ Pathology:
– lung diseases
– → oblliterates the vascular bed Or interferes
with the oxygen perfusion
– →hypoxia
– →The Main and second degree branches dilatates
and peripheral Branches elongates
– →pul. arterial hypertention
– →increased pressure of right V.
– →right V. Enlargement.
 X-ray features of pulmonary heart disease :

♦ 1. diseases of lungs:
– Chronic bronchitis ,

– Emphysema ,
– Brochiectasis ,
– T.b ,
– Plueral thickening ,
 X-ray features of pulmonary heart disease

♦ 2. changes of
heart:
♦ right V. enlargement :
– P-A view :
infundibulum bulge ,
right border swollen ,
apex of the heart is
higher.
– LAO: right V. expands.
 X-ray features of pulmonary heart disease

♦ 3. changes of large vessels (pul. arterial hypertention):

– 1).the pul. artery segment bulge and vigorous
pulsation .
– 2).right basal artery dilates and exceeds 15 mm in
diameter.
– 3).peripheral arteries is small.
 Pericarditis

♦ (pericardial effusion
♦ constrictive pericarditis)
 Pericardium anatomy :
♦ 1. It covers heart , ascending aorta , pul. trunk
nearly to its bifurcation .
♦ 2. Pericardial cavity consists of a visceral and a
parietal layer and contains 15-30 ml of fluid .250-
500 ml effusion can be detected by x-ray
examination .
 X-ray features of pericardial effusion

♦ cause :
– acute non-specific pericarditis ,
– viral pericarditis ,
– T.b ,
– rheumatic fever .
X-ray Features of pericardial effusion

♦ 1.change in heart size and

shape .
– triangular , flask-like or
globular in shape .
– (distribution may be
symmetrical )
♦ 2. loss of normal cardiac
contours .
♦ 3.alteraion in shape of
heart in posture.
– triangular shape (stand),
globular shape(supine)
X-ray Features of pericardial effusion

♦ 4.aorta shortens
(pericardium covers
the proximal half of
the ascending aorta .
♦ svc widens (effusion
prevents blood in svc
from entering right
atrium)
 X-ray Features of pericardial effusion

♦ 5. pulsation of heart
diminishes or absent
(intra-pericardium ) .
♦ pulsation of aorta is
normal (extro-
pericardium).
♦ 6. normal lungs
 congenital heart diseases
♦ classification
------on the basis of blood flow of lungs:
– 1.plethora : atrial septal defect (ASD) , ventricular
septal defect (VSD), patent ductus arteriosus (PDA).
– 2.Oligemia : tetralogy of Follot , pul. valve stenosis ,
tricupid stenosis, et al.
Atrial septal defect (ASD)
 Atrial septal defect (ASD)
♦ In fetus there are septum primum and septum secundum
between right atrium and left artrim . The septum primum
has a ostium primum and ostium secumdum . The septum
secundum has a ostium oval . Ostium secumdum defect is
very common .
 Atrial septal defect (ASD)
♦ Dysplasia of septum secundum or excessive
absorption of septum primum can lead to defect of
ostium secumdum . (the position of defect is high)
 Secondary ostium type
♦ Hemodynamic:
– 1. There is a shunt from
left atrium to right
atrium→ dilatation of
right atrium , right V.
and main stem of pul.
artery→pul. plethora.
– 2. A shunt from left to
right→decreased blood
flow in left V. and aorta
→small.
 X-ray features of ASD

1.changes of lungs: ◆ plethora

♦ a.pul. artery segment bulge.
♦ b. Right basal artery ≥15 mm
♦ c. Vigorous pulsation of hilum vessels.
 X-ray features of ASD

♦ 2.changes of heart:
– a.◆right auricular
enlargement.
– b. Right V.
enlargement ,
main stem of pul.
artery
enlargement.
– c. ◆Left atrium
and left V. not
enlargement.
 X-ray features of ASD

♦ 3.changes of large
vessels:
– ◆aortic knuckle
small.
 stium primum type
♦ It occurs low down in the close to the mitral
valve,with a deformity of the mitral valve.
 stium primum type
---Hemodynamics:

♦ 1.shunt is from left to right auricle,R.A

enlargement ,
♦ 2.a mitral leak—L.V enlargement
 stium primum type
--- X-ray features :

♦ It has additional change: complicate mitral leak →

left V. enlargement.
– 1. L.A enlargement
– 2. L. V. enlargement.
– 3. plethora
Tetralogy of Fallot
 Tetralogy of Fallot

♦ It is one of commonest congenital heart disease

associated with cyanosis . It includes four major
abnormalies :
– pul. stenosis,
– Dextroposition of the aorta ,
– high VSD,
– R. V hypertrophy :
 Tetralogy of Fallot
♦ 1.pul. stenosis:
– a main malformation. Common seen
infundibulum . in some instance , “ third V.” is
formed between stenosis and pul. valve because
the constriction occurs in the most proximal
aspect of R.V outflow tract.
♦ 2.High VSD:
– another main malformaion . membrane of
ventricular septum . large defect.
 Tetralogy of Fallot

♦ 3.Dextroposition of the
aorta : secondary
change. Aorta
displaces to right and
anterior direction
♦ 4.Right V. hypertrophy
:secondary change . It
is the result of
pulmonary stenosis .
 Tetralogy of Fallot
♦ 1.The heart is “boot-
shaped’,because of R.V
enlargement and
elevation of apex
♦ 2.the pulmonary artery
segment is
concave,suggesting that
pulmonary stenosis is
present.
♦ 3.the hilar and
peripheral pulmonary
arterial branches are
delicate