The Chest X-ray Still common In patient Portable imaging ‘Morning Portables’ Pre-op Post-op Out...
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Transcript of The Chest X-ray Still common In patient Portable imaging ‘Morning Portables’ Pre-op Post-op Out...
![Page 1: The Chest X-ray Still common In patient Portable imaging ‘Morning Portables’ Pre-op Post-op Out patient Still effective but possibly overused.](https://reader036.fdocuments.in/reader036/viewer/2022062516/56649d9d5503460f94a87432/html5/thumbnails/1.jpg)
The Chest X-ray
• Still common• In patient• Portable imaging
• ‘Morning Portables’• Pre-op• Post-op• Out patient
• Still effective but possibly overused
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http://cdn.lifeinthefastlane.com/wp-content/uploads/2012/08/CXR-AP.jpghttp://lifeinthefastlane.com/investigations/cxr-normal/
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Right AtriumRight Ventricle
Right Ventricle
Left Ventricle Left VentricleLeft Atrium
Left Atrium
The Chambers
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The Pulmonary and Aortic Vessels
Main Pulmonary ArteryRDPA Main Pulmonary ArteryLDPA
Aortic Arch Aortic Arch
Descending Aorta Descending Aorta
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This Lecture
• Pulmonary Hypertension• Ventricular Septal Defect• Mitral Stenosis vs Mitral Regurgitation• Aortic Stenosis
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Pulmonary HTN
• Increase in pulmonary vascular resistance
• Mean pulmonary artery pressure (PAP) >25mmHg at rest• At least 30 mmHg during exercise• Mean pulmonary wedge pressure < 15mmHg
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Causes
• Group 1• Idiopathic• Pulmonary Arterial Hypertension
• Group 2• Left Heart Disease• Pulmonary Venous Hypertension
• Group 3• Hypoxemia• COPD
• Group 4• Group 5
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Clinical Indications
• Dyspnea on exertion
• Dizziness
• Syncope
• Angina
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Radiographic Indicators
• Prominent main pulmonary artery• Convex shadow along the left cardiac border (PA)
• Right ventricle enlargement• Increased cardiac border in contact with anterior chest wall
(Lat)
• Right descending pulmonary enlargement• Transverse diameter is greater than 16mm
• Pruning of peripheral pulmonary vessels• Abrupt tapering of distal pulmonary vessels with loss of side
branches
• Pleural effusion/Pulmonary Edema
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Case courtesy of Dr Frank Gaillard, Radiopaedia.org
Prominent Main Pulmonary Artery and Trunk
Enlarged RDPA
Pleural Effusion
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http://posterng.netkey.at/esr/viewing/index.php?module=viewing_poster&task=viewsection&pi=100743&ti=311759&searchkey=
Enlarged Right Ventricle
Enlarged Pulmonary Trunk
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Miniati et al. Accuracy of chest radiography in predicting pulmonary hypertension:A case-control study. M. Miniati et al. / Thrombosis Research 133 (2014) 345–351
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http://www.vcuthoracicimaging.com/Historyanswer.aspx?qid=40&fid=1
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Ventricular Septal Defect
• Holes in the ventricular septum• Conoventricular• Perimembranous• Inlet• Muscular
• Most common congenital cardiac malformation• Up to 50% in congenitally malformed hearts
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Causes
• Can exist in isolation
• Or existing with other malformations:• Tetralogy of Fallot• Double outlet right ventricle• Transposition• Univentricular hearts
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Clinical Indications
• Dependent on size• May be asymptomatic• May be cyanotic
• Retardation of growth• Pulmonary HTN• Pulmonary edema• Wheezing• Tachypnea
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Radiographic Indicators
• Cardiomegaly• Can be difficult to diagnose due to the thymus
• Increased pulmonary vascular markings
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Normal
http://www.scielo.br/scielo.php?pid=S0100-39842006000600012&script=sci_arttext&tlng=en
Ventricular Septal Defect
http://radiopaedia.org/articles/ventricular-septal-defect-1
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Normal Cardiomegaly
RADIOLOGIC CLINICS OF NORTH AMERICAVOLUME 37 * NUMBER 6 * NOVEMBER 1999
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Ventricular Septal Defect
http://radiopaedia.org/cases/ventricular-septal-defect
Case courtesy of Dr Frank Gaillard, Radiopaedia.org
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Spicer et al. Orphanet Journal of Rare Diseases (2014) 9:144
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Tetralogy of Fallot
http://radiopaedia.org/cases/tetralogy-of-fallot-1">Tetralogy of Fallot
Ventricular Septal Defect
Right Ventricular outflow track obstruction
Overriding Aorta
Right Ventricular Hypertrophy
Let’s Think What Happens
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Mitral Stenosis
• Leaflet thickening resulting in narrowing of the mitral valve.
• Causes• Rheumatic Fever
• Common in developing countries• Degenerative
• Common in developed countries
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Healthy Mitral Valve Mitral Valve Stenosis
Fish Mouth Appearance
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Mitral Regurgitation
• Systolic retrograde flow from the left ventricle into the left atrium.
• Causes• Non-Ischemic
• Degenerative• Endocarditis• Rheumatic
• Ischemic
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http://www.vetmed.ucdavis.edu/vmth/small_animal/cardio_kittleson/cases/case9/figures.htm
Healthy Mitral Valve
http://nethealthbook.com/cardiovascular-disease/heart-disease/mitral-valve-disease/
Mitral Valve Prolapse
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Clinical Indicators
• Dyspnea
• Exercise Intolerance
• Long Murmur
• Pulmonary HTN
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Radiographic Indicators
• Left atrial enlargement• Double Density• Splayed Carina
• Decreased aortic knob
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LALV
RVRA
LA
LVRVRA
Double Density and Splayed Carina
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http://radiopaedia.org/articles/mitral-valve-regurgitation
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http://www.learningradiology.com/lectures/cardiaclectures/valvularlesions2012/Valvular%20Lesions%20of%20the%20Heart/Valvular%20Lesions%20of%20the%20Heart.html
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http://radiologyinthai.blogspot.com/2010_06_01_archive.html
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http://static.wikidoc.org/3/3a/Left-atrial-enlargement-002.jpg
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Aortic Stenosis
• Narrowing of the aortic valve.
• Causes:• Age (Calcific AS, Senile)
• Similar to atherosclerosis• Rheumatic Valve • Congenital
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Normal Aortic ValveCalcific Aortic Stenosis
http://www.slideshare.net/drranjithmp/echo-assessment-of-aortic-stenosis
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Clinical Indicators
• Angina
• Syncope
• Heart Failure
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Radiographic Indicators
• Aortic Valve Calcification
• Prominent Ascending Aorta
• Left Ventricular Enlargement
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http://www.learningradiology.com/archives2011/COW%20480-aortic%20stenosis/ascorrect.htm
Ascending aorta projects farther than right atrium
Normal Descending Aorta
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Calcified Aortic Valve
http://www.learningradiology.com/archives04/COW%20118-Aortic%20Stenosis/ascorrect.htm
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Where are those valves?
A
M
http://web.stanford.edu/dept/radiology/radiologysite/site141.html
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AM
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Aortic Valve
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Mitral Valve
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Reference• Barbosa E, Gupta N, Torgian D, Gefter W. (2012). Current Role of imaging in the diagnosis and management of pulmonary
hypertension. American Journal of Roentgenology. 198, 1320-1331
• Batson G, Urquhart W, Sideris D. (1972). Radiologic Features in Aortic Stenosis. Clinical Radiology. 23, 140-144
• Carabello, Blase. (2013). Introduction to aortic stenosis. Circulation Research . , 113, 179-185.
• Carabello, B & Paulus W. (2009) Aortic Stenosis. The Lancet., 373, 956-966
• Chandrashekhar Y, Westaby S, Narula J. Mitral Stenosis. (2009). The Lancet., 374, 1271-1283
• Coussement, Alain & Gooding Charles. (1973). Objective Radiographic Assessment of Pulmonary Vascularity in Children. Radiology. 109, 649-654
• Delnevo A, Tritella S, Carbonaro L, Bobrechova O, Leo G, Sardanelli F. (2012). The use of bedside radiography at a university hospital. Data on a two-week period. Euopean Journal of Radiology. 81, 260-263
• Enriquez-Sarano, M, Akins C, Vahanian, A. (2009). Mitral Regurgitation. The Lancet., 373, 1382-1394
• Matthay R, Schwarz M, Ellis J, Steele P, Siebert P, Durrance J, Levin D.. (1981). Pulmonary Artery Hypertension in Chronic Obstructive Pulmonary Disease: Determination by Chest Radiography. Investigative Radiology. 16, 95-100
• Miniati M, Monti S, Airo E, Pancani R, Formichi B, Bauleo C, Marini C. (2014). Accuracy of chest radiography in predicting pulmonary hypertension: A case-control study. Thrombosis Research. 133, 345-351
• Palazzeti V, Gasparri E, Gambini C, Sollazzo S, Saric S, Salvolini L, Giovagnoni A. (2013). Chest radiography in intensive care: an irreplaceable survey? Radiologia Medica. 118, 744-751
• Sethi R. (2010). An Approach to Assessing the Chest Radiograph. British Journal of Hospital Medicine. 71(11), 172-17
• Shah, Sanjiv.. (2012) Pulmonary Hypertension. Journal of American Medical Association. 308(13), 1366-1374
• Spicer D, Hsu H, Co-Vu J, Anderson R, Fricker F. Ventricular Septal Defect. (2014). Orphanet Journal of Rare Diseases. 9(144), 1-16
• Strife Janet & Sze, Raymond. (1999). Radiographic Evaluation of the Neonate with Congenital Heart Disease. Radiologc Clinics of North America. 37(6), 1093-1107
• Tumkosit M, Yingyong N, Mahayosnond A, Choo K, Goo H. (2012). Accuracy of chest radiography for evaluating significantly abnormal pulmonary vascularity in children with congenital heart disease. International Journal of Cardiovascular Imaging. 28, 69-75
• Zarco, P. (2003). Aortic stenosis. European Heart Journal. , 24, 133-135.