Cardiovascular System1

Cardiovascular System

Zhengzhou university 1st affiliated hospital interventional department

Ma’nan( 马南 )

Cardiovascular System Method of Examination  Physical

examination  Echocardiography,  Radionuclide examinations  X-ray examinations  CT – CT --- Normal CT – SCT-- Spiral CT(hispeed CT) – UCT --Ultrafast CT

 MRI

Cardiovascular System *Method of X-ray examinations  Fluoroscopy

or screening  Teleradiography-2m—plain films  Cardiac catheterization  Angiocardiography – Selective angiocardiography

 Kymography

X-ray plain films

Cardiac catheterization

Cardiac catheterization

Cardiac catheterization

Angiocardiography - Selective angiocardiography

Cardiovascular System X-Ray plain films

 Normal

Cardio-vascular Shadow

– Postero-Anterior view (P-A view) – Right anterior oblique view (RAO view or 1st oblique) – Left anterior oblique view(LAO view or 2nd oblique

view) – Lateral view

(LL , RL view)

Cardiovascular System P-A view

Cardiovascular System P-A view

Cardiovascular System P-A view

 Right

border:

– The cardio-phrenic angle – The inferior vena cava. – The ascending aorta & the superior vena cava.  adult - the ascending aorta dose not project outwards over the shadow of the superior vena cava.  olderly people with physiological unfolding of the aorta, this situation is reversed and the ascending aorta with a long convex curve forms the whole of the upper shadow.

Cardiovascular System P-A view

 Right

border:

– The cardio-phrenic

angle – The inferior vena cava. – The ascending aorta & the superior vena cava.

the ascending aorta on P-A view

Cardiovascular System P-A view



The left cardiac border . – the left ventricle. – the appendage – pulmonary artery. – the aortic knuckle – the left cardio-phrenic angle

Cardiovascular System P-A view

(RAO view or 1st oblique) This view is obtained by rotating the patient to the left so that his right shoulder is touching the screen. The angle of rotation is usually 45 degrees.

 the

anterior border   

 The

aorta, right ventricle the left ventricle

posterior border  

the left auricle lie against the esophagus

Cardiovascular System (RAO view or 1st oblique)

Cardiovascular System (LAO view or 2nd oblique)



This view is taken by rotating the patient so that the left shoulder is touching the screen. The angle of rotating is usually 60-70 degrees.

Cardiovascular System (LAO view or 2nd oblique)

 the

anterior contour (1) the ascending part of the aorta;  (2) the appendage of right auricle;  (3) the edge of the right ventricle. 

 The

posterior contour

(1) a small part of left auricle;  (2) the left ventricle.  (3) The aortic arch, the descending aorta 

– aortic window. the aortic triangle.

Cardiovascular System (LAO view or 2nd oblique)

 the

anterior contour

– (1) the ascending part of

the aorta; – (2) the appendage of right auricle; – (3) the edge of the right ventricle

Cardiovascular System (LAO view or 2nd oblique)

 The

posterior contour

– (1) a small part of left

auricle; – (2) the left ventricle. – (3) The aortic arch, the descending aorta  

aortic window. the aortic triangle.

Cardiovascular System (LAO view or 2nd oblique)

Cardiovascular System (LL view) 

In the lateral view the heart shadow is seen on the anterior half of the diaphagm. The heart shadow lie adjacent to the lower third of the sternum and xiphisternum.

Cardiovascular System (LL view)

 The

anterior border

– the right ventricle – the infundibulum. – pulmonary arteries – the ascending aorta

Cardiovascular System (LL view)  The

posterior border

– the left atrium above – the left ventricle below – The descending aorta

may be seen in the elderly . – the inferior vena cava.

Cardiovascular System (LL view)

Physiological factors influencing the shape and size of the heart  (1)

Body built:  (2) Age:  (3) Respiration:  (4) Posture:  (5)Other

Physiological factors influencing the shape and size of the heart - Body built

Physiological factors influencing the shape and size of the heart -Age:

Physiological factors influencing the shape and size of the heart - Respiration

1st lesson over

Basic X-ray Features in Diseases of Cardiovascular System 

1)Enlargement of heart – – – – –

  

(1) Left ventricular enlargement: (2) Right ventricle enlargement: (3) Left auricular enlargement: (4) Right auricular enlargement: (5) General enlargement of heart:

2).change of aorta 3)Abnormal pulsation in cardio-vascular diseaes: 4)Pathological change in the pulmonary circulation: – (1) Plethora: (2) Oligemia: (3) Pulmonary arterial hypertention: – (4) Pulmonary venous hypertention: (5) Thrombo-emboic disease:

The cardiothoracic ratio (CTR) 

Overall heart size is most easily assessed on plain chest radiographs. The cardiothoracic ratio (CTR) is a widely used but crude method of measurement; in normal people the transverse diameter of the heart is usually less than half the internal diameter of the chest

Enlargement of heart

*(1) Left ventricular enlargement:  In

the P-A view

– the left side of the heart becomes more

globular, the apex of the heart extends downwards, posteriorly and to the left. – It can been seen under the shadow of the diaphragm through the gas bubble of the fundus of stomach. – The point of opposite pulsation is pushed upwards.

Enlargement of heart (1) Left ventricular enlargement:

Enlargement of heart

*(1) Left ventricular enlargement  In

the LAO position

– it becomes increasingly difficult to clear the left

border from the spine. In some cases it is possible to identify the interventricular groove in the LAO position. This indentation is displaced downwards and forwards in enlargement of the left ventricle. – Left ventricle enlargement is best assessed in PA, LAO and lateral views.

Enlargement of heart (1) Left ventricular enlargement:

Enlargement of heart

*(2) Right  The

ventricular enlargement:

common causes are mitral stenosis, congenital failure, chronic pulmonary diseases  The right ventricle enlarges chiefly to the left and anteriorly.  In the P-A view , the whole of the left border is formed by the right ventricle.  the point of opposite pulsation is pushed downwards.

Enlargement of heart

*(2) Right 

ventricular enlargement:

In the LAO view, – the retrosternal space become smaller – the interventricular groove and the left ventricle backward and

upward displacement. 

In the RAO view, – a large right ventricle extends very high up the retrosternal space – the infundibulum region is prominent. – the heart rotate to the left, so as to make the aortic knuckle less

prominent.

Enlargement of heart (2) Right ventricular enlargement

Enlargement of heart **(3) Left atrium enlargement:     

The common cause of left auricular enlargement is mitral disease. The enlargement is displace to the right and posterior. the left main bronchus moves upwards. the esophagus displaces backwards and to the right. the left auricular appendage is enlarged and forms part of the left contour.

Enlargement of heart (3) Left atrium enlargement

Enlargement of heart (3) Left atrium enlargement:

Right atrium enlargement  The

commen cause of right auricular enlargement are right heart failure, tricuspid disease and ASD.  Enlargement of the right auricle is predominantly to the right and anteriorly.  In the P-A view there is enlargement and bulging of the right heart border is bulging and the angle formed with the aorta is getting smaller, may be as small as a right angle.

Right atrium enlargement

Right atrium enlargement

General enlargement of heart: This occurs with combined valvular lesions, advanced stages of failure, myocardial weakness, endocrine disturbances (myxedema) and severe or chronic anemic. Certain congenital heart diseases.  the shadow is increased to the left and right,  the oblique views show narrowing of both the retrosternal and retrocardiac spaces .  the trachea bifurcation is splayed  Lateral views are especially helpful in general enlargement of the heart. 

General enlargement of heart:

General enlargement of heart

2nd lesson over

change of aorta  The

aorta is relatively fixed at two points, the heart and the diaphragm.



If its elasticity is diminished or if the blood flow or pressure through it is increased, it must alter its shape , lenth and position between these two points.

 It

can be caused :

– (1)by an increase in the minute volume flow of blood such

as occurs in aortic incompetence ; – (2)by hypertention – (3)by degenerative or inflammatory changes causing fibrosis and loss of elasticity

change of aorta 

Elongation and widening of the aorta are characterised in the P-A view by a convex projection of the ascending aorta on the right side and a considerable increase in the distance between the notch separating aorta from right auricle and the point where the aorta comes into the mediastinum. The notch is lower than normal, so that the right auricular shadow appears small.

change in the pulmonary circulation:

(1) Plethora:

change in the pulmonary circulation:

(2) Oligemia

change in the pulmonary circulation:

(2) Oligemia

change in the pulmonary circulation: (3) Pulmonary arterial hypertention 

Pathological change in the pulmonary circulation: – (2) Oligemia: : – (4) Pulmonary venous hypertention: (5) Thrombo-emboic disease:

change in the pulmonary circulation: (3) Pulmonary arterial hypertention

change in the pulmonary circulation: (4) Pulmonary venous hypertention: