cvs imaging level v.ppt

7/27/2019 CVS IMAGING LEVEL V.ppt

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CARDIOVASCULAR

IMAGING

LEVEL V MBCHB

BY DR ONYAMBU

LECTURER DDIRM


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Objectives

Understand the different modalities for

imaging the cardiovascular system

Know the optimal modality for each

clinical indication


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IMAGING MODALITIES

Plain CXR-PA,LAT

Echocardiography

Isotope scanning Cardiac catheterisation

Angiocardiography

CT MRI


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PLAIN X-RAYS

Plain radiographs are important as thefirst imaging investigation in cases ofheart disease. It gives vital information

concerning: Size of the heart

Enlargement of individual chambers

Pulmonary vasculature

Condition of the lung fields

Presence or absence of pleural effusion


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SIZE OF THE HEART

Measured by the cardio-thoracic ratio

(CTR)

The maximum transverse diameter of the

heart is compared to the maximum

transverse diameter of the chest.

In normal adults this is


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THE SHAPE OF THE HEART

The cardiac contour has characteristic

appearance in specific conditions

depending on the chambers mainly

enlarged.

LV enlargement is seen in HTN, and

aortic valve disease

The apex enlarges downward and to the left


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LV ENLARGEMENT


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THE LEFT ATRIUM

LA enlargement is seen in mitral valve

disease,

Enlarges backwards and to the right

Double density of the heart

Projects backwards and slightly upwards in

the lateral film .

Makes an impression on the barium filledoesophagus.


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MR

Severe MR disease

.Left atrial appendageis large , producing a

convex bulge (arrow).

The heart is

considerably enlarged


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VSD


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RIGHT VENTRICULAR

ENLARGEMENT

May also be seen in mitral disease due

to increased pulmonary resistance

secondary to pulmonary congestion

Also seen in congenital cardiac lesions

associated with pulmonary stenosis or L-

R shunts.

Pulmonary disease with chronic airway

obstruction


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RV

Lifting and rounding of the apex

Filling of the retrosternal airspace


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LUNG FIELDS

CONGESTION-due to pulmonaryvenous hypertension following left heartlesions resulting in back pressure on the

lung. Causes include; LV failure andmitral valve disease.

CXR

Diversion of blood from the lower to theupper zones of the lung in an erect PA filmof the chest


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Cont

Pulmonary oedema with interstitial or

alveolar involvement

Septal lines- Kelly A,B and C

Lamellar effusions

Alveolar oedema is often perihilar with

blurring of the central lung areas (batswing appearance)

Pleural effusions may be seen.


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PULMONARY PLETHORA

Seen in conditions of high pulmonary flowmainly due to congenital L-R shunts.

Both arteries and veins become prominent

with end on vessels close to the hilum beingparticularly well seen, and distal vesselsextending to the lung periphery

PAH (pulmonary arterial hypertension) may

develop in long standing ASD, increasedresistance caused by severe pulmonaryvenous HTN


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Cont..

PAH may develop acutely following

massive pulmonary embolus or from

chronic multiple pulmonary emboli.

PAH also occurs in chronic pulmonary

disease with chronic airways obstruction


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X-Ray Findings-ASD

Enlarged

pulmonary

vessels Normal-sized

left atrium

Normal tosmall aorta.


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PULMONARY OLIGAEMIA

Occurs when there is obstruction to the

pulmonary outflow at or below the

pulmonary valves.

It may be seen in R-L shunt as in

tetralogy of Fallot


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PERICARDIAL EFFUSION

May be classified as

1.Inflammatory

-TB -Supprative

-Rheumatic -Viral

2.Non-inflammatory

-heart failure -myocardial infarction

-Uraemia -Haemopericardium

3.Malignant


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Pericardial effusion

The radiological diagnosis can be difficult

unless the fluid is more than 200 mls.

R.F

Enlarged globular heart

Masking of the hilar

U/S is diagnostic

CT or MRI may show the effusion


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CXR-pericardial effusion


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CCF


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Kerley A & B lines


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Plain radiographs:-

- normal

Myocardial perfusion studies:-

scintiscans of the heart are taken at

rest and after exercise.Thallium 201 is taken up by viable

perfused myocardium.

Thallium 201 is injected during exercise

test with immediate exercise images and

perfusion images 3 hrs later, after resting

Myocardial Ischaemia

IMAGING FEATURES


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Myocardial perfusion

study.

Thallium scan

showing reversibleanterior myocardium

ischaemia.

Images are x-

sectional tomograms

of the left ventricle.

cvs imaging level v.ppt

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