Cardiovascular System2

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: – LAO:

infundibulum is prominent . 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 .250500 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 (extropericardium). ♦ 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