CARDIAC ANATOMY

And
COMMON PATHOLOGIES

Maria Theresa Navarro, M.D.

Quirino Memorial Medical Center
Department of Medical Imaging
CARDIAC ANATOMY

Part I
RIGHT ATRIUM
smooth posterior wall develops from
the sinus venosus
where the SVC and IVC
attached
opening of coronary sinus
trabeculated anterior wall – from
embryonic right atrium
Fossa ovalis – in the medial and
posterior wall of the interatrial septum
• RIG HT VENT RI CL E
• Inflow o r s inu s p or tion
• Tra bec ula te d
• Poste rior or in ferior
por tion
• Outf lo w tra ct or
pu lmo na ry c onu s
• Les s tra be cu la te d
• An te rio r or s up er ior
por tion
• div id ed by the cr ista
sup ra ventric ula ris
• mu scula r rid ge wi th a
sept al ba nd c alle d
th e mod er at or ba nd
• Mod era to r Ba nd –
co nne ct s th e
inte rven tr icu lar sep tu m
to the a nt er ior p ap il la ry
mu scle
• Co nt ain s th e rig ht
bun dle br an ch
• Infun dib ulum (conu s
ar te riosus)
• smoot h cephal ic port ion o f
the ri ght ventr icl e
• that leads to the pulm onar y
trunk
• LE FT AT RIU M
• highe st and mo st poste rio r
cha mb er
• nes tled betwe en th e rig ht an d
lef t br on chi
• pos ter ior wa ll abu ts th e
ant er ior wa ll o f th e
esop ha gus
• Lef t atr ial a pp en dag e
• sm all pouch that proj ect s
super iorly and to the lef t
• sm oother and longer than th e
right atr ial appendage
• For am en ovale
• wi thi n t he inter atr ial septum
• LE FT VEN TR IC LE
• Inflow p or tion
• pos te rior to the
anterior portion of
the anterior mitral
leaf let
• Outf low tract
• anterior and
super ior to th e
anterior mitral
leaf let
• PUL MON ARY T RU NK
• fro m t he righ t v entric ula r
ou tf low tr ac t
• po ste rio r t o th e a orta
an d to t he le ft
• div id es in to righ t a nd l eft
pu lmo na ry a rt er ies
• PULMON AR Y TR UNK
• 4-5 cm i n l eng th
• 3 cm in diam et er
• lie s with in th e
per icar dia l sac

• RI GH T P ULMO NARY
ART ERY
• behi nd t he ascendi ng
aor ta, SVC, and ri ght
upper pul monary ve in
• DE SCE NDING BRA NCH of
the r ight pul mo nary
art er y
− 10- 16 mm in m en
− 9- 15 m m in wom en

• LEF T P ULMO NARY

ART ERY
• Intr aper icar di al for a
• AORT A
• As cending

• trans vers e / arch

• des cending
• beg ins a t t he
liga me ntu m or duct us
arte rio sum

• Ligamentum
arterios um
• re mna nt of d uc tu s
arte rio sus
• clos es f unc tio na ll ly
with in 2 4 h ou rs o f lif e
• ana to my b y 1 0 da ys
of l if e f oll owing birt h
Cardiac Valves
CORONARY
ARTERIES
 LAD

LAD LCX

RCA LAD

LAD

LAD RCA

RCA

L L
A C
D X
Axial Anatomy
Normal Roentgenographic
Anatomy
Postero-Anterior (PA)
View
• Right border
• Superior vena cava
• Right atrium
• Inferior vena cava

• Left border
• Aortic knob
• Main pulmonary
trunk
• Left ventricle
Postero-Anterior (PA)
View

• Pulmonary Arteries
• Right
• Left
Left Atrium

LA
Lateral View
Right Anterior Oblique
Left Anterior Oblique
Pla in Film
Inter pr etation
• L and R atria (AP) = <3.8 cm
• L and R atria (lateral) = <4.5 cm
• L and R atria (apex to base) = <6.0
cm
• L V (end systole) = < 4.0 cm
• LV (end diastole) = < 5.2 cm
• RV = < 3.8 cm
• Interventricular septum and
posterior myocardium = <1.1 cm
• Aortic root = < 3.5 cm
• IVC = < 2.0 cm
CARDIAC SIZE
 Right Atrial
Enlargement
• lateral bulging of the
right heart border
• elongation of the right
heart border (length
of right heart border
exceeds 50% of the
mediastinal
cardiovascular
shadow)
 Right Ventricular
Enlargement

• PA View: Rounding
and upliftment of
cardiac apex
 Right Ventricular
Enlargement
• PA View: Rounding
and upliftment of
cardiac apex
• Lateral View:
Retrosternal fullness
(contact of anterior
cardiac border
greater than 1/3 of
the sternal length
 Left Atrial
Enlargement
• PA view:
• Double density
• Enlargement of LA
appendage
• Upliftment of left
mainstem bronchus
• Widening of carinal
angle
 Left Atrial
Enlargement

• Lateral view:
• Prominent
posterosuperior
cardiac border
• Posterior displacement
and upliftment of left
mainstem bronchus
 Left Ventricular
Enlargement
• PA View: lateral and
downward
displacement of the
cardiac apex
• “droopy” or “saggy”
 Left Ventricular
Enlargement
• Lateral view:
• posterior displacement
of the posterior inferior
border of the heart
• Hof fm an- Rigler S ign :
measured 2 cm above
the intersection of the
diaphragm & IVC; (+) if
posterior border
extends more than 1.8
cm of IVC
HOFFMAN-
RIGLER SIGN
PULMONARY VASCULAR
PATTERN

NORMAL
 INCREASED PULMONARY
VASCULAR PATTERN

NORMAL INCREASED
 INCREASED PULMONARY
VASCULAR PATTERN

NORMAL INCREASED
DECREASED VASCULAR PATTERN

NORMAL DECREASED
DECREASED PULMONARY
VASCULAR PATTERN

NORMAL DECREASED
CAUSES

• INCREASED • DECREASED
PULMONARY PULMONARY
VASCULARITY VASCULARITY
• right ventricular • right outflow
output is more than obstruction
twice the left
ventricular output
• left sided
obstructive lesions
Swischuck, LE., Basic
Imaging in Congenital
Heart Disease 3rd Ed.
CAUSES

• NORMAL PULMONARY
VASCULARITY
• Uncomplicated valvular or
vascular lesions
PULMONARY CONGESTION

• Active • Passive
Congestion Congestion
• Pulmonary venous
• With L to R shunts congestion
• ASD • Left-sided
• VSD obstructive lesions
• PDA or myocardial
dysfunction
• Increased blood
• Dilation of
volume flowing pulmonary veins
through and transudation
pulmonary of fluid into the
congestion perivascular
Swischuck, LE., Basic
tissues
Imaging in Congenital
(pulmonary
Heart Disease 3rd Ed.
PULMONARY CONGESTION

• Passive Congestion
• Total Anomalous Pulmonary Venous
Return
• Pulmonary Vein Atresia
• Hypoplastic Left Heart Syndrome
PULMONARY VASCULAR PATTERN

VENOUS
NORMAL
CONGESTION
PULMONARY VASCULAR PATTERN

Kerley’s B lines

VENOUS
CONGESTION
ANATOMIC CONSIDERATIONS

• TWO MAJOR COMPARTMENTS OF THE

LUNG (in which excess fluid may
accumulate)

• INTERSTITIAL SPACE
• AIR-SPACE
 ANATOMIC CONSIDERATIONS

• INTERSTITIAL SPACE

intralobular centrilobular
interstitium interstitium

Interlobular septa

peribronchovascular
interstitium

subpleural
interstitium

secondary pulmonary lobule

ANATOMIC CONSIDERATIONS

• AIR SPACE
Mechanism of Pulmonary Edema

TWO FACTORS
• Balance Exudation of
between fluid from the
capillary and capillaries into
plasma oncotic the interstitial
pressure tissues and air-
• Maintenance of spaces of the
normal lungs
capillary wall

Fraser and Pare

• KERLEY B - 1 cm or less interlobular septal lines
• lower lung zones, peripherally
• parallel to each other but at right
• angle to the pleural surface
• KERLEY A LINES – 4 cm in length upper and mid
• lung
• deep septal lines (lymphatic channels)
• radiate from the hila into the central
• portions but do not reach the pleura
• more acute or severe form of edema
• KERLEY C – overlapping Kerley B lines (no longer
use)
 ROENTGENOGRAPHIC
MANIFESTATIONS

• INTERSTITIAL EDEMA
• AIR-SPACE EDEMA
CAUSES OF PULMONARY EDEMA
• Hemodynamic or Elevated
Microvascular Pressure (EMP)
• most common
• mitral stenosis
• left ventricular decompensation
• Permeability or Normal Microvascular
Pressure (NMP)
• increased permeability of the alveolar-
capillary wall barrier
• result of toxic injury (or other influenced)
 THE GREAT ARTERIES

• Aorta
• normal
• prominent
• diminutive
• Main pulmonary
artery
• normal
• prominent
• flat
• concave
 THE GREAT ARTERIES

• Aorta
• normal
• prominent
• diminutive
• Main pulmonary
artery
• normal
• prominent
• flat
• concave
 THE GREAT ARTERIES

• Aorta
• normal
• prominent
• diminutive
• Main pulmonary
artery
• normal
• prominent
• flat
• concave
 THE GREAT ARTERIES

• Aorta
• normal
• prominent
• diminutive
• Main pulmonary
artery
• normal
• prominent
• flat
• concave
 THE GREAT ARTERIES

• Aorta
• normal
• prominent
• diminutive
• Main pulmonary
artery
• normal
• prominent
• flat
• concave
 THE GREAT ARTERIES

• Aorta
• normal
• prominent
• diminutive
• Main pulmonary
artery
• normal
• prominent
• flat
• concave