Download Pericarditis

Plain CXR :PA & lateral view
 Echocardio-study
 Radioisotop scan
 Computed tomography
 MRI
 Cardiac cartheritization & angiography.
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Size & shape of the heart
 Pulmonary vessels
 Aorta.
 lungs
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Hear size usually measured on plain CXR
by Cardiothoracic ration ,Normal ratio is
less than 50%.
 On serial CXR more than 1.5cm changes
in widest cardiac daim. indicated
cardiomegaly.
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Normal
2.
Increase pul. blood flow(pulmonary plethora). Due to Lt.-Rt shunt
3.
decrease pul. blood flow(pulmonary oligemia). Ex. TOF
4.
Pul. Venous hypertension .
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upper zone vessels equal or enlarge than lower zone vessels
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Pulmonary edema.
5. Pul. arterial hypertension”
Causes:
Core pulomale
Pul. Embloi
Mitral valve disease, or LT.-RT shunt.
idiopathic
Features:
enlargement of pulmonary A.& hilar arteries
1.
Pericarditis
 Cardiomyopathy
 Heart failure

CXR
 PA view increase C/T ratio
 Lat. decrease in size of retrocardiac &
retrosternal spaces , backward
displacement of esophagus


Cardiac enlargement+/- selective
chamber enlargement
 Increased pulmonary venous pressure
( increase vasculairty in upper lung
zones)
 Pulmonary edema
 pleural effusion. usually bilateral RT.
Larger than LT. but if unilateral its s almost
always Rt.side.
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Causes
 Mitral stenosis/ regurgitation
 LVF
 LA myxoma
 VSD
 PDA
Double right heart border
 >75° splaying of carina with horizontal
orientation of left main bronchus
 Enlarged left convex left atrial
appendage
 Increased density of chamber
 >7 cm distance between left main stem
bronchus and right lateral LA shadow

>7 cm distance between
left main stem bronchus
and right lateral LA
shadow
>75° splaying
of carina with
horizontal
orientation of
left main
bronchus
Increased convexity of posterio-superior
cardiac margin
 Posterior displacement of left main
bronchus
 Posterior displacement of barium filled
esophagus

Tricuspid stenosis/ regurgitation
 ASD
 AF
 Ebstein anomaly
 Pulmonary atresia

Increase in curvature of RT heart border.
 Prominent round superior border at
junction with SVC
 >5.5 cm from midline to most lateral RA
margin
 >2.5 cm from right vertebral margin

Pressure overload: Hypertension , AS
 Volume overload: VSD, AR, MR
 Aneurysm
 Cardiomyopathy

Enlarges in post, inferior and leftward
direction
 Increased Cardiothoracic ratio
 Larger radius of curvature of left heart
border
 Downturned cardiac apex
 Depression of left hemidiaphragm

Increased convexity of posteroinferior
cardiac margin
 Hofman rigler rule: posterior cardiac
margin projects >1.8 cm post to IVC
measured at a point 2cm above
intersection of IVC with right
hemidiaphragm

PV stenosis
 Cor pulmonale
 ASD
 Tricuspid regurgitation
 Secondary to LVF
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Only extreme dilatation causes signs on frontal
view
Straightening/ convexity of left upper cardiac
contour
Upturned cardiac apex
Left upper cardiac margin parallels left main
stem bronchus as a long convex curvature
Large appearance of MPA
Occurs higher on the left heart border
between left ventricular contour and
pulmonary outflow tract
Prominent convexity of ant heart border
>1/3 distance from anterior
cardiophrenic sulcus to sternal angle
 Increased size prominent in retrosternal
area

Mitral valve disease
 Mitral stenosis
Radiological sign:
1.Lt atrial enlargement with normal cardiac
size
2. Mitral valve calcification
3.Increase pulmonary venous pressure.
4.Pulmonary edema.
Lt atrial &Lt.ventricular enlargement
(increase cardiac size with LT ventricular
configuration..
 Pulmonary edema
 Increase pulmonary venous pressure.

Aortic stenosis:
1. valve calcification
2. Poststenotic dilation in ascending aorta
3. LT ventricular enlargement
4. Pul. venous hypertension.
3&4 are late features

Dilated ascending aorta.
 Lt. ventricular enlargement (early)

Stenosis& regurgitation:
Enlargment of Rt.atruim & SVC.

Pulmonary stenosis
Normal cardiac size
Enlargement of main pul. A.
Coarctaion of aorta:
1.Indentaion on aortic arch.
2.Dilation above coarctation due to Lt.subclavian A. enlargement
3.Dilation below coarctation due to poststenotic dilation of aorta.
4. Cardiac enlargmnt
50. Rib indentation : in long standing cases small cortical rib
indentation due to enlargements of intercostal vessels.
 Tetralogy of fallot :
VSD
Overriding of aorta
Rt ventricular outflow obstruction
RV hypertrophy.
Radiological features:
1. Normal CXR 50%.
2. Boot shape heart
3. Oligaemic lung
4. Rt side aorta in 25%.
1.
2.
3.
Cardiac enlargement.
Enlargement of Lt. main PA.
pulmonary plethora.
 Lt
atrial myxoma
Most common benign cardiac tumor .it may
arise from intra-atrial septum or cardiac wal
Radiological features:
Best seen by cardiac MRI or echocradic
study.
Most patient have normal CXR.
It may pedineculates floating within atrium to
mitral valve causing MV dysfunction mimic
MS or MR.
pericardial effusion
Marked increase in cardiac diam. With no
specific chamber enlargements.
Calcifications seen up o 50% of constrictive
pericarditis.
By echo study :
As little as 25-50cc can be seen as echofree fluid echogenisty between cardiac
wall &pericarduim.
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Pericarditis is defined as inflammation of the pericardium. It is
normally found in association with cardiac, thoracic or wider
systemic pathology and it is unusual to manifest on its own.
It can be sub typed according to morphology.
Acute forms
serous pericarditis
suppurative (purulent) pericarditis
tuberculous (caseous) pericarditis :
fibrinous pericarditis
haemorrhagic pericarditis
Established forms
constrictive pericarditis
adhesive pericarditis
Radiographic features
CT / Carciac CT
At contrast-enhanced CT, enhancement of the thickened
pericardium generally indicates inflammation 1.
Cardiac MRI
Usually T1, T2 and GRE cine sequences are performed.
The normal pericardial thickness is considered 2 mm while a
thickness of over 4 mm suggests a pericarditis The presence of
an arrthymia may induce artefacts.
Normal aortic daim
1. Ascending=5cm
2. Arch=4cm
3. Descending=3cm
4. Abdominal =2cm

Aneurysms are focal abnormal dilatation of a blood vessel. They typically occur in
arteries, venous aneurysms are rare. Aneurysms may also occur in the heart.
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Pathology

Pathological types

true aneurysm

false aneurysm (or pseudoaneurysm)
Causes

congenital

atherosclerosis

hypertension

vasculitis
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hereditary connective tissue disorders
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›
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Marfan syndrome
Ehlers-Danlos syndrome
fibromuscular dysplasia
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infection: mycotic aneurysm, syphilis (luetic aneurysm)
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trauma
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iatrogenic
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myocardial infarction: may cause left ventricular aneurysm
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flow related (in cerebral AVM, contralateral ICA occlusion etc)
Morphology:
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saccular aneurysm: eccentric, involving only a portion of the circumference of the
vessel wall
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fusiform aneurysm: concentric, involving full circumference of the vessel wall
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Complications

rupture
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distal thromboembolism
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pressure effects
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Thanks