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Cardiovascular

system

Soehartinah Kramadibrata
Antono
Bag/SMF Radiologi
FK. UNPAD / RSUP. Dr. Hasan Sadikin
Introduction
Anatomy and pathology
Summary
Introduction
1. History : anatomy of cardiovascular
Cardiovascular -- 16 th century -- autopsy, ECG

2. Modalities
Without x ray
ECG
MRI
Radiopharmacy Nuclear medicine Tc 99 m th
204
Introduction
With X - rays
Without contrast media : chest X rays,
fluoroscopy, EBCT
With contrast media: Esophagography,
interventional cardiography EBCT

3. Indication : Suspect abnormalities of CV


and lung disease based on clinical diagnosis
ANATOMY AND PATHOLOGY
1. Chest X Ray
Standard projections and technical
consideration :
high Kv 120-145, lov KV 60-80
Position : postero-anterior, lateral, oblique

Deep inspiration, suspended breath


Distance : 72 inches/ 180-200 cm
2. Mediastinum
The heart and great vessels occupy the mid
thorax,
within the mediastinum
The anatomic borders of the mediastinum :
1. Anteriorly : the sternum and its adjacent ribs
2. Posteriorly : the vertebral column and its ribs
3. Laterally : the medial aspects of the parietal
pleuras
4. Superiorly : the plane of the 1st rib
5. Inferiorly : the diaphragm
3. Heart image on chest X-ray
- Opaque silhoutte
- Mostly located in left hemithorax
- Aortic arch
- Diaphragm
4. Influence factor of the heart
contour
1. The age : infant / newborn : more
rounded and transversal
Childhood
Adult

2. Respiration
Deep inspiration
Expiration
Chest X Rays of normal neonatus
1. Focus - film distance

2. Habitus - pycknicus and asthenicus

3. Abnormalities of the spine, sternum,


the lungs --rotation of the heart
4. Position of the patient, erect, supine
Adult chest X Rays
5. Evaluation of the chest X-ray
Technical aspect : KV, mAs, Artifact,
blurring, distance

Object aspect : deep inspiration,


symmetrical, supine, erect
6. Cardiothoracic
ratio

M = midline
A = 1/3 C1
B = C1
D + E = 4 cm
F = height of the aorta, 2 cm form the edge of the manubrium
A+B
CTR = C1 + C2 X 100%
7. Visualisation of the heart structures
Postero-anterior projection : RA, RV, LV
Lateral projection : RV, LV, LA -- PA, AA
Right anterior oblique projection :
LA,RA, RV--AA
Left anterior oblique projection : RV --
RAA, LV-LA, PA
8. Imaging of the lungs vascular
Close relation between the lungs
vascular and abnormalities of the
heart, vice versa
Pulmonary arteries

Pulmonary veins

Aorta
Pulmonary artery/veins
Normally : Blood (RV) --> thru PA --> Right
and Left Lungs
PA tributaries (small arteries) with bronchi
to the alveoli capillaries
PVs (capillary plexus) in alveoli septa -->
to medial part of the lungs --> wider --> LA
PVs of the lungs basis --> to the lower part
of LA
PVs of the other part of the lungs --> to
the upper part of LA
Pulmonary artery
Hilum : consist of the pulmonary
artery, pulmonary veins, bronchus
and nodes
Right hilum : in the middle of right
lungs, apex and right diaphragm
Left hilum : higher than the right
hilum
Adult chest X Rays
Pulmonary artery
Hilum : consist of the pulmonary
artery, pulmonary veins, bronchus and
nodes
Right hilum : in the middle of right
lungs, apex and right diaphragm
Left hilum : higher than the right hilum
PATHOLOGY
ABNORMALITIES OF LUNG VASCULATURES

Abnormalities of pulmonary vessels


Vascular widening
Vascular narrowing
Pathways irregularity
Vascular widening
Hilum enlargement > 16 mm, conform with
trachea
node enlargement - prominent-
mediastinal enlargement
pulmonal artery widening(MPA)
volume increase--- L to R shunt, VSD,
VSD,PDA
obstruction in periphery artery
ASD,VSD,PDA Pulmonary art >------ capillaries in
lungs >, pulmonary veins>MPA at hilum >>
Pulmonary artery >> -fibrosis, emphysema,
atelectasis, and pulmonary veins congestion of
lungs
Vascular narrowing
Vascular narrowing : pulmonary stenosis

: decrease of blood volume in lungs,

---small hilum, small and smooth

periphery vessels, more radio lucent


Abnormality of the aorta
Pitfalls : rotation of the heart, asymmetrical of
chest X ray
Widening of the aorta :
Increase blood volume : leakage septal, R to L
Obstruction of its tributaries at the periphery level :
Coarctatio aorta, stenosis Aorta--Takayashu
disease --- abdominal aorta
Abnormality of the aorta itself --widening in chronic
hypertension
Narrowing of the aorta
Decrease of blood volume to the aorta --- septal
leakage L to R, mitral stenosis
Malposition of the heart
Dextrocardia
Dextroversion
Mesoversion
Levocardi
Dextrocardia : heart, aorta and apex are in the
right hemithorax
Most often accompanied by situs inversus
Dextroversion : heart turns right
Heart in right hemothorax
Apex turned down
LV at frontal side
RV turns right-posteriorly
Mesoversion : heart in the middle of thoracal
cavity
Levocardi : - heart in left hemithorax
- abdominal organ in right side
Enlargement of the heart
1. Enlargement of the heart image
pericardial disease : pericardial effusion
myocardial disease : enlargement of the
cardiac chambers, cardiomyopathy
valvular disease : stenosis, insufficiency
2. Enlargement of the heart chambers :
hypertrophy, dilatation
Right atrial enlargement
PA : extension to right of right atrial border,
with increased convexity
RAO : slight posteroinferior convexity
LAO : increases supero-inferior convexity
(prominence of right atrial auricle)
LAT : right atrium protrudes behind esophagus
Right atrial enlargement
Right ventricle enlargement
(hypertrophy & dilatation)
PA : enlargement heart to left side
enlargement dilatation of pulmonary arteries
increased convexing of heart waist, pushing
pulmonary arteries to upper side
RAO : increased prominence of pulmonary sector
(bulguing of MPA)
LAO : bulging on anterior aspect of RV
LAT : right ventricle clumbs upward, close to
the sternum
Right ventricular hyperthropy & dilatation

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