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HEART DISEASES
PARVATHY R
LEFT ATRIUM
DOES NOT
FORM ANY
PART OF
CARDIAC
SILHOUETTE
IN A NORMAL
PA VIEW
3 MOGULS OF HEART
LEFT MEDIASTINAL OUTLINE STARTING AT THE AORTIC KNOB.
1. AORTIC KNUCKLE
PROMINENT KNOB = ANEURYSM/HYPERTENSION
ABSENT KNOB = LOOK TO THE RIGHT
2. PULMONARY ARTERY
EXCESSIVE CONVEXITY - POSTSTENOTIC
DILATATION/COPD/PAH/L2R SHUNTS/PERICARDIAL DEFECTS.
SEVERE CONCAVITY - R2L shunts.
RETROTRACH. SPACE:
VASCULAR
ESOPHAGEAL
THRYOID
RETROCARDIAC SPACE:
HIATUS HERNIA
LV ENLARGEMENT
ESOPHAGEAL DISORDERS
PNEUMONIA
CHAMBER ENLARGEMENT
LEFT ATRIUM
7 CM
1. ATRIAL ESCAPE
2. WALKING MAN SIGN
90 DEG
RIGHT ATRIUM
Atrial bulge too far to the right of the spine
(more than 5.5 cm from the midline on a wellpositioned PA radiograph).
Right atrial convexity to exceed 50% of the
mediastinal or cardiovascular shadow.
LEFT VENTRICLE
RIGHT VENTRICLE
Normal
Looking through
ostium primum
defect
at cleft mitral valve
Proximity of ostium
primum defect to
tricuspid valve
Enlargement of RA and RV
ASSOCIATIONS
ASSOCIATIONS
HOLT ORAM syndrome
ostium secundum ASD,
conduction defects and
skeletal abnormalities of
upper extremity (absent
thumb, absent / dysplastic
radius)
CHD a/w upper limb anomaly rather than lower limb anomaly.
Echocardiography
Cornerstone of the diagnosis of CHD
2D imaging shows the defect in almost all the cases
Ostium primum & secundum are easily
differentiated.
Sinus venosus are difficult to visualize.
Right side chamber enlargement is well seen
Echocardiography
Doppler study
M mode shows paradoxical motion of the interatrial
septum
Color flow :
In localizing the defect
To diagnose any valvar regurgitation
To R/O Venous anomalies
MR ADJUNCT TO ECHO
inlet
RADIOLOGICAL
FINDINGS
Small VSD NORMAL
Medium to large VSD
VSD - LATERAL
VIEW
LA & RV ENLARGEMENT
ECHOCARDIOGRAPHY
Echo is vital in the differential
diagnosis of these conditions.
ECHOCARDIOGRAPHY
Color Doppler
Flow jet (*) across the defect into the right ventricle,
indicating a left-to-right shunt.
MRI
MEMBRANOUS TYPE
CARDIAC CT
artery
Patent Ductus
Arteriosus
General
Anatomy
Physiology
Pathophysiology
Ductus
bump
IMAGING - RADIOGRAPH
Calcifications
Punctate calcifications at site of closed ductus
is a normal finding
Linear or railroad track calcification at the site
of ductus may be seen in adults with PDA
ECHOCARDIOGRAPHY
MRI
CARDIAC CT
ASSOCIATIONS
Development of AP septum
AORTOPULMONARY WINDOW
Underdevelopment or
perforation of the
septum dividing the
fetal truncus
Appearances may be
identical with PDA or
VSD
PAH occurs early.
MRI
Memory Aid
1.
Anomalous
pulmonary
SHAPED)
2.
3.
Hypoplasia
of
pulmonary artery.
4.
Anomalous systemic
supply to lower lobe
ipsilateral
arterial
SCIMITAR SYNDROME
Subvalvular
Valvular
Supra valvular
Associated with Williams syndrome
RADIOLOGICAL FEATURES
Cardiomegaly.
LV hypertrophy.
Poststenotic dilatation of aorta in valvular AS.
Small ascending aorta in supravalvular form.
SUPRA
VALVULAR
VALVULAR
TYPES
Infundibular ( subvalvular) common in TOF
Valvular (classic PS)
Supravalvular stenosis (60%)
Normal pulmonary
vascularity and cardiac size
COARCTATION OF AORTA
Narrowing at level of distal arch / descending aorta.
Associated with bicuspid aortic valve (75%), cerebral
aneurysms (5-10%) and Turner syndrome (20% have
coarctation)
Post-ductal coarctation
NOTCHING OF RIBS
Due to collateral flow through dilated, tortous ,
pulsatile posterior intercostal arteries
Anterior ribs are spared because anterior intercostal
artery do not run in costal grooves.
Seen > 10 yrs
Not seen in first two ribs as first and second posterior
intercostal arteries arise not from aorta but from
costocervical trunk of subclavian.
Usually bilateral, medial third of postr.ribs not involved
NOTCHING OF RIBS
When coarctation narrows the orifice of LSA , only
right sided notching seen
When there is anomalous origin of RSA distal to
coarctation collaterals fail to develop in right
hemithorax so only left sided notching seen.
PSEUDOCARCTATION OF AORTA
Buckling or kinking of aorta in the vicinity of
ligamentum arteriosum, resulting in elongation,
tortuosity of
distal aortic arch and proximal
descending aorta
Plain X-ray
Figure 3 sign
No rib notching
COR TRIATRIATUM
Obstructing membrane
between the true LA
cavity and the
diverticulum.
Severe pulmonary
venous congestion and
oedema.
The right ventricle is
hypertrophied, the left
ventricle (LV) is of normal
size
COR TRIATRIATUM
Mild pulmonary
edema pattern with
enlarged slightly
hazy pulmonary
vessels.
Cardia is not overtly
enlarged.
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