Cardiac Anatomy And Common Pathologies
This document was uploaded by user and they confirmed that they have the permission to share it. If you are author or own the copyright of this book, please report to us by using this DMCA report form. Report DMCA
Overview
Download & View Cardiac Anatomy And Common Pathologies as PDF for free.
More details
- Words: 1,524
- Pages: 83
CARDIAC ANATOMY And COMMON PATHOLOGIES
Maria Theresa Navarro, M.D. Quirino Memorial Medical Center Department of Medical Imaging
CARDIAC ANATOMY Part I
RIGHT ATRIUM smooth posterior wall develops from the sinus venosus where the SVC and IVC attached opening of coronary sinus trabeculated anterior wall – from embryonic right atrium Fossa ovalis – in the medial and posterior wall of the interatrial septum
•
RIG HT VENT RI CL E •
•
•
•
Inflow o r s inu s p or tion • Tra bec ula te d • Poste rior or in ferior por tion Outf lo w tra ct or pu lmo na ry c onu s • Les s tra be cu la te d • An te rio r or s up er ior por tion div id ed by the cr ista sup ra ventric ula ris • mu scula r rid ge wi th a sept al ba nd c alle d th e mod er at or ba nd Mod era to r Ba nd – co nne ct s th e inte rven tr icu lar sep tu m to the a nt er ior p ap il la ry mu scle • Co nt ain s th e rig ht bun dle br an ch
•
Infun dib ulum (conu s ar te riosus) • •
smoot h cephal ic port ion o f the ri ght ventr icl e that leads to the pulm onar y trunk
•
LE FT AT RIU M • • • •
highe st and mo st poste rio r cha mb er nes tled betwe en th e rig ht an d lef t br on chi pos ter ior wa ll abu ts th e ant er ior wa ll o f th e esop ha gus Lef t atr ial a pp en dag e • •
•
sm all pouch that proj ect s super iorly and to the lef t sm oother and longer than th e right atr ial appendage
For am en ovale •
wi thi n t he inter atr ial septum
•
LE FT VEN TR IC LE • Inflow p or tion • pos te rior to the anterior portion of the anterior mitral leaf let • Outf low tract • anterior and super ior to th e anterior mitral leaf let
•
PUL MON ARY T RU NK • • •
fro m t he righ t v entric ula r ou tf low tr ac t po ste rio r t o th e a orta an d to t he le ft div id es in to righ t a nd l eft pu lmo na ry a rt er ies
•
PULMON AR Y TR UNK • • •
4-5 cm i n l eng th 3 cm in diam et er lie s with in th e per icar dia l sac
•
RI GH T P ULMO NARY ART ERY • •
•
behi nd t he ascendi ng aor ta, SVC, and ri ght upper pul monary ve in DE SCE NDING BRA NCH of the r ight pul mo nary art er y − 10- 16 mm in m en − 9- 15 m m in wom en
LEF T P ULMO NARY ART ERY •
Intr aper icar di al for a
•
AORT A • As cending • trans vers e / arch • des cending • beg ins a t t he liga me ntu m or duct us arte rio sum
• Ligamentum arterios um • re mna nt of d uc tu s arte rio sus • clos es f unc tio na ll ly with in 2 4 h ou rs o f lif e • ana to my b y 1 0 da ys of l if e f oll owing birt h
Cardiac Valves
CORONARY ARTERIES
LAD
LAD
LCX RCA
LAD
LAD
LAD
RCA
RCA
L A D
L C X
Axial Anatomy
Normal Roentgenographic Anatomy
Postero-Anterior (PA) View • Right border • Superior vena cava • Right atrium • Inferior vena cava
• Left border • Aortic knob • Main pulmonary trunk • Left ventricle
Postero-Anterior (PA) View • Pulmonary Arteries • Right • Left
Left Atrium
LA
Lateral View
Right Anterior Oblique
Left Anterior Oblique
Pla in Film Inter pr etation
• L and R atria (AP) = <3.8 cm • L and R atria (lateral) = <4.5 cm • L and R atria (apex to base) = <6.0 cm • L V (end systole) = < 4.0 cm • LV (end diastole) = < 5.2 cm • RV = < 3.8 cm • Interventricular septum and posterior myocardium = <1.1 cm • Aortic root = < 3.5 cm • IVC = < 2.0 cm
CARDIAC SIZE
Right Atrial Enlargement • lateral bulging of the right heart border • elongation of the right heart border (length of right heart border exceeds 50% of the mediastinal cardiovascular shadow)
Right Ventricular Enlargement • PA View: Rounding and upliftment of cardiac apex
Right Ventricular Enlargement • PA View: Rounding and upliftment of cardiac apex • Lateral View: Retrosternal fullness (contact of anterior cardiac border greater than 1/3 of the sternal length
Left Atrial Enlargement • PA view: • Double density • Enlargement of LA appendage • Upliftment of left mainstem bronchus • Widening of carinal angle
Left Atrial Enlargement • Lateral view: • Prominent posterosuperior cardiac border • Posterior displacement and upliftment of left mainstem bronchus
Left Ventricular Enlargement • PA View: lateral and downward displacement of the cardiac apex • “droopy” or “saggy”
Left Ventricular Enlargement • Lateral view: • posterior displacement of the posterior inferior border of the heart • Hof fm an- Rigler S ign : measured 2 cm above the intersection of the diaphragm & IVC; (+) if posterior border extends more than 1.8 cm of IVC
HOFFMANRIGLER SIGN
PULMONARY VASCULAR PATTERN
NORMAL
INCREASED PULMONARY VASCULAR PATTERN
NORMAL
INCREASED
INCREASED PULMONARY VASCULAR PATTERN
NORMAL
INCREASED
DECREASED VASCULAR PATTERN
NORMAL
DECREASED
DECREASED PULMONARY VASCULAR PATTERN
NORMAL
DECREASED
CAUSES • INCREASED PULMONARY VASCULARITY • right ventricular output is more than twice the left ventricular output • left sided obstructive lesions
• DECREASED PULMONARY VASCULARITY • right outflow obstruction
Swischuck, LE., Basic Imaging in Congenital Heart Disease 3rd Ed.
CAUSES • NORMAL PULMONARY VASCULARITY • Uncomplicated valvular or vascular lesions
PULMONARY CONGESTION • Active Congestion • With L to R shunts • ASD • VSD • PDA
• Increased blood volume flowing through pulmonary congestion
• Passive Congestion
• Pulmonary venous congestion • Left-sided obstructive lesions or myocardial dysfunction • Dilation of pulmonary veins and transudation of fluid into the perivascular Swischuck, LE., Basic tissues Imaging in Congenital (pulmonary Heart Disease 3rd Ed.
PULMONARY CONGESTION • Passive Congestion
• Total Anomalous Pulmonary Venous Return • Pulmonary Vein Atresia • Hypoplastic Left Heart Syndrome
PULMONARY VASCULAR PATTERN
NORMAL
VENOUS CONGESTION
PULMONARY VASCULAR PATTERN
Kerley’s B lines
VENOUS CONGESTION
ANATOMIC CONSIDERATIONS •
TWO MAJOR COMPARTMENTS OF THE LUNG (in which excess fluid may accumulate) • •
INTERSTITIAL SPACE AIR-SPACE
ANATOMIC CONSIDERATIONS •
INTERSTITIAL SPACE
intralobular interstitium
centrilobular interstitium
Interlobular septa peribronchovascular interstitium
subpleural interstitium
secondary pulmonary lobule
ANATOMIC CONSIDERATIONS •
AIR SPACE
Mechanism of Pulmonary Edema TWO FACTORS • Balance
between capillary and plasma oncotic pressure
• Maintenance of normal capillary wall
Exudation of fluid from the capillaries into the interstitial tissues and airspaces of the lungs
Fraser and Pare
• KERLEY B - 1 cm or less interlobular septal lines • lower lung zones, peripherally • parallel to each other but at right • angle to the pleural surface • KERLEY A LINES – 4 cm in length upper and mid • lung • deep septal lines (lymphatic channels) • radiate from the hila into the central • portions but do not reach the pleura • more acute or severe form of edema • KERLEY C – overlapping Kerley B lines (no longer use)
ROENTGENOGRAPHIC MANIFESTATIONS
INTERSTITIAL EDEMA • AIR-SPACE EDEMA •
CAUSES OF PULMONARY EDEMA •
Hemodynamic or Elevated Microvascular Pressure (EMP) • • •
•
most common mitral stenosis left ventricular decompensation
Permeability or Normal Microvascular Pressure (NMP) • •
increased permeability of the alveolarcapillary wall barrier result of toxic injury (or other influenced)
THE GREAT ARTERIES • Aorta • normal • prominent • diminutive
• Main pulmonary artery • • • •
normal prominent flat concave
THE GREAT ARTERIES • Aorta • normal • prominent • diminutive
• Main pulmonary artery • • • •
normal prominent flat concave
THE GREAT ARTERIES • Aorta • normal • prominent • diminutive
• Main pulmonary artery • • • •
normal prominent flat concave
THE GREAT ARTERIES • Aorta • normal • prominent • diminutive
• Main pulmonary artery • • • •
normal prominent flat concave
THE GREAT ARTERIES • Aorta • normal • prominent • diminutive
• Main pulmonary artery • • • •
normal prominent flat concave
THE GREAT ARTERIES • Aorta • normal • prominent • diminutive
• Main pulmonary artery • • • •
normal prominent flat concave
Maria Theresa Navarro, M.D. Quirino Memorial Medical Center Department of Medical Imaging
CARDIAC ANATOMY Part I
RIGHT ATRIUM smooth posterior wall develops from the sinus venosus where the SVC and IVC attached opening of coronary sinus trabeculated anterior wall – from embryonic right atrium Fossa ovalis – in the medial and posterior wall of the interatrial septum
•
RIG HT VENT RI CL E •
•
•
•
Inflow o r s inu s p or tion • Tra bec ula te d • Poste rior or in ferior por tion Outf lo w tra ct or pu lmo na ry c onu s • Les s tra be cu la te d • An te rio r or s up er ior por tion div id ed by the cr ista sup ra ventric ula ris • mu scula r rid ge wi th a sept al ba nd c alle d th e mod er at or ba nd Mod era to r Ba nd – co nne ct s th e inte rven tr icu lar sep tu m to the a nt er ior p ap il la ry mu scle • Co nt ain s th e rig ht bun dle br an ch
•
Infun dib ulum (conu s ar te riosus) • •
smoot h cephal ic port ion o f the ri ght ventr icl e that leads to the pulm onar y trunk
•
LE FT AT RIU M • • • •
highe st and mo st poste rio r cha mb er nes tled betwe en th e rig ht an d lef t br on chi pos ter ior wa ll abu ts th e ant er ior wa ll o f th e esop ha gus Lef t atr ial a pp en dag e • •
•
sm all pouch that proj ect s super iorly and to the lef t sm oother and longer than th e right atr ial appendage
For am en ovale •
wi thi n t he inter atr ial septum
•
LE FT VEN TR IC LE • Inflow p or tion • pos te rior to the anterior portion of the anterior mitral leaf let • Outf low tract • anterior and super ior to th e anterior mitral leaf let
•
PUL MON ARY T RU NK • • •
fro m t he righ t v entric ula r ou tf low tr ac t po ste rio r t o th e a orta an d to t he le ft div id es in to righ t a nd l eft pu lmo na ry a rt er ies
•
PULMON AR Y TR UNK • • •
4-5 cm i n l eng th 3 cm in diam et er lie s with in th e per icar dia l sac
•
RI GH T P ULMO NARY ART ERY • •
•
behi nd t he ascendi ng aor ta, SVC, and ri ght upper pul monary ve in DE SCE NDING BRA NCH of the r ight pul mo nary art er y − 10- 16 mm in m en − 9- 15 m m in wom en
LEF T P ULMO NARY ART ERY •
Intr aper icar di al for a
•
AORT A • As cending • trans vers e / arch • des cending • beg ins a t t he liga me ntu m or duct us arte rio sum
• Ligamentum arterios um • re mna nt of d uc tu s arte rio sus • clos es f unc tio na ll ly with in 2 4 h ou rs o f lif e • ana to my b y 1 0 da ys of l if e f oll owing birt h
Cardiac Valves
CORONARY ARTERIES
LAD
LAD
LCX RCA
LAD
LAD
LAD
RCA
RCA
L A D
L C X
Axial Anatomy
Normal Roentgenographic Anatomy
Postero-Anterior (PA) View • Right border • Superior vena cava • Right atrium • Inferior vena cava
• Left border • Aortic knob • Main pulmonary trunk • Left ventricle
Postero-Anterior (PA) View • Pulmonary Arteries • Right • Left
Left Atrium
LA
Lateral View
Right Anterior Oblique
Left Anterior Oblique
Pla in Film Inter pr etation
• L and R atria (AP) = <3.8 cm • L and R atria (lateral) = <4.5 cm • L and R atria (apex to base) = <6.0 cm • L V (end systole) = < 4.0 cm • LV (end diastole) = < 5.2 cm • RV = < 3.8 cm • Interventricular septum and posterior myocardium = <1.1 cm • Aortic root = < 3.5 cm • IVC = < 2.0 cm
CARDIAC SIZE
Right Atrial Enlargement • lateral bulging of the right heart border • elongation of the right heart border (length of right heart border exceeds 50% of the mediastinal cardiovascular shadow)
Right Ventricular Enlargement • PA View: Rounding and upliftment of cardiac apex
Right Ventricular Enlargement • PA View: Rounding and upliftment of cardiac apex • Lateral View: Retrosternal fullness (contact of anterior cardiac border greater than 1/3 of the sternal length
Left Atrial Enlargement • PA view: • Double density • Enlargement of LA appendage • Upliftment of left mainstem bronchus • Widening of carinal angle
Left Atrial Enlargement • Lateral view: • Prominent posterosuperior cardiac border • Posterior displacement and upliftment of left mainstem bronchus
Left Ventricular Enlargement • PA View: lateral and downward displacement of the cardiac apex • “droopy” or “saggy”
Left Ventricular Enlargement • Lateral view: • posterior displacement of the posterior inferior border of the heart • Hof fm an- Rigler S ign : measured 2 cm above the intersection of the diaphragm & IVC; (+) if posterior border extends more than 1.8 cm of IVC
HOFFMANRIGLER SIGN
PULMONARY VASCULAR PATTERN
NORMAL
INCREASED PULMONARY VASCULAR PATTERN
NORMAL
INCREASED
INCREASED PULMONARY VASCULAR PATTERN
NORMAL
INCREASED
DECREASED VASCULAR PATTERN
NORMAL
DECREASED
DECREASED PULMONARY VASCULAR PATTERN
NORMAL
DECREASED
CAUSES • INCREASED PULMONARY VASCULARITY • right ventricular output is more than twice the left ventricular output • left sided obstructive lesions
• DECREASED PULMONARY VASCULARITY • right outflow obstruction
Swischuck, LE., Basic Imaging in Congenital Heart Disease 3rd Ed.
CAUSES • NORMAL PULMONARY VASCULARITY • Uncomplicated valvular or vascular lesions
PULMONARY CONGESTION • Active Congestion • With L to R shunts • ASD • VSD • PDA
• Increased blood volume flowing through pulmonary congestion
• Passive Congestion
• Pulmonary venous congestion • Left-sided obstructive lesions or myocardial dysfunction • Dilation of pulmonary veins and transudation of fluid into the perivascular Swischuck, LE., Basic tissues Imaging in Congenital (pulmonary Heart Disease 3rd Ed.
PULMONARY CONGESTION • Passive Congestion
• Total Anomalous Pulmonary Venous Return • Pulmonary Vein Atresia • Hypoplastic Left Heart Syndrome
PULMONARY VASCULAR PATTERN
NORMAL
VENOUS CONGESTION
PULMONARY VASCULAR PATTERN
Kerley’s B lines
VENOUS CONGESTION
ANATOMIC CONSIDERATIONS •
TWO MAJOR COMPARTMENTS OF THE LUNG (in which excess fluid may accumulate) • •
INTERSTITIAL SPACE AIR-SPACE
ANATOMIC CONSIDERATIONS •
INTERSTITIAL SPACE
intralobular interstitium
centrilobular interstitium
Interlobular septa peribronchovascular interstitium
subpleural interstitium
secondary pulmonary lobule
ANATOMIC CONSIDERATIONS •
AIR SPACE
Mechanism of Pulmonary Edema TWO FACTORS • Balance
between capillary and plasma oncotic pressure
• Maintenance of normal capillary wall
Exudation of fluid from the capillaries into the interstitial tissues and airspaces of the lungs
Fraser and Pare
• KERLEY B - 1 cm or less interlobular septal lines • lower lung zones, peripherally • parallel to each other but at right • angle to the pleural surface • KERLEY A LINES – 4 cm in length upper and mid • lung • deep septal lines (lymphatic channels) • radiate from the hila into the central • portions but do not reach the pleura • more acute or severe form of edema • KERLEY C – overlapping Kerley B lines (no longer use)
ROENTGENOGRAPHIC MANIFESTATIONS
INTERSTITIAL EDEMA • AIR-SPACE EDEMA •
CAUSES OF PULMONARY EDEMA •
Hemodynamic or Elevated Microvascular Pressure (EMP) • • •
•
most common mitral stenosis left ventricular decompensation
Permeability or Normal Microvascular Pressure (NMP) • •
increased permeability of the alveolarcapillary wall barrier result of toxic injury (or other influenced)
THE GREAT ARTERIES • Aorta • normal • prominent • diminutive
• Main pulmonary artery • • • •
normal prominent flat concave
THE GREAT ARTERIES • Aorta • normal • prominent • diminutive
• Main pulmonary artery • • • •
normal prominent flat concave
THE GREAT ARTERIES • Aorta • normal • prominent • diminutive
• Main pulmonary artery • • • •
normal prominent flat concave
THE GREAT ARTERIES • Aorta • normal • prominent • diminutive
• Main pulmonary artery • • • •
normal prominent flat concave
THE GREAT ARTERIES • Aorta • normal • prominent • diminutive
• Main pulmonary artery • • • •
normal prominent flat concave
THE GREAT ARTERIES • Aorta • normal • prominent • diminutive
• Main pulmonary artery • • • •
normal prominent flat concave
Related Documents
Cardiac Anatomy And Common Pathologies
May 2020 2
Cardiac Anatomy
December 2019 14
Common Problems Cardiac, Respiratory Outline.docx
November 2019 4
Cardiac
April 2020 21
Cardiac
December 2019 40
Anatomy
April 2020 28More Documents from ""
Cardiac Anatomy And Common Pathologies
May 2020 2
Renal Neoplasm
June 2020 3
Osteochondroses
May 2020 0
Radiology Physics X-ray Production
June 2020 0