Download Chest X * Ray : Heart Failiure

Chest X – Ray : Heart Failure
Dr.Juan A.Venter
Dept.Imaging Sciences
Universitas Hospital
Causes:PVH/Pulmonary Oedema
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Left Ventricular Failiure
Left Ventricular Outflow Obstruction
Mitral Valve Disease
Left Atrial Myxoma
Fibrosing Mediastinitis
Pulmonary Venous Occlusive Disease
Non Cardiogenic Pulmonary Oedema –
Normal Cardiothoracic Index
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Aspiration ,Near Drowning
ARDS
Hepatorenal Failiure
Post thoracocenthesis – Rapid Lung Expansion
Drugs : Aspirin,Nutrofurantoin,Opiates,Cytokines
PS:Early post MI phase – acute decrease in
miocardial compliance
Right Atrial Enlargement
PA CXR:
• Prominent round superior border with SVC
• > 5,5 cm from midline to most lateral RA
margin
• > 2,5 cm from right vertebral margin
Right Ventricular enlargement
PA CXR:
• Upturned cadiac apex
Lateral CXR:
• > 1/3 contact distance from cadiophrenic
sulcus to sternal angle
Left Atrial Enlargement
PA CXR:
• Retrocardiac double density
• >75 % splaying of carina with horizontal
orientation of left mainstem bronchus
• Enlarged left convex left atrial appendage
• > 7 cm from LMB to right LA border.
Lateral CXR:
• Posterior displacement of Ba filled oesophagus
Left Ventricle Enlargement
PA CXR:
• Downturned cardiac apex with leftward
displacement
• Left diaphragmatic inversion
Lateral CXR:
• Posterior cardiac margin > 1,8 cm posterior to IVC
meassured 2 cm above intersection of right
hemidiaphragm with IVC.(Hofman-Rigler rule)
Cardiac vs Non Cardiac Oedema
Signs
Cardiac
Renal /Fluid
Overload
CARDIOMEGALY
(uremic
pericarditis)
VASCULAR REDISTRIBUTION
Balanced
ARDS
WIDENED VASCULAR PEDICLE
KERLEY LINES
PERIBRONCHIAL CUFFING
AIRSPACE OPACIFICATION
Basal
Central
PLEURAL EFFUSIONS
Very
Common
Common
Diffuse
Congestive Cardiac Failiure
Stages of CCF
Stage 1
PCWP 13-18 mmHg
Redistribution
Stage 2
PCWP 18 – 25 mmHg
Interstitial Oedema
Stage 3
PCWP > 25 mmHg
Alveolar Oedema
Redistribution/Cephalization
Redistribution
Interstitial Oedema
Interstitial Oedema
Interstitial Oedema
Alveolar Oedema
Alveolar Oedema
Gravity dependent density differences
Cardiothoracic Index
Pleural Effusion
Vascular Pedicle Width: < 60 mm,
> 85mm , 5mm = 1l
VPW – Serial CXR
Azygos Vein Width :
Erect > 10 mm , Supine > 15 mm , Serial X Rays >
3mm,Not depending on in - or expiration
Right Ventricular Failiure
References
1.www.radiology assistant.nl – accessed
27/02/2012
2.Primer of Diagnostic Imaging – Fourth Edition
3.Radiology Review Manual – 6 th Edition