1. Chest X – Ray : Heart Failure
Dr.Juan A.Venter
Dept.Imaging Sciences
Universitas Hospital

2. Causes:PVH/Pulmonary Oedema
Left Ventricular Failiure
Left Ventricular Outflow Obstruction
Mitral Valve Disease
Left Atrial Myxoma
Fibrosing Mediastinitis
Pulmonary Venous Occlusive Disease

3. Non Cardiogenic Pulmonary Oedema – Normal Cardiothoracic Index
Aspiration ,Near Drowning
ARDS
Hepatorenal Failiure
Post thoracocenthesis – Rapid Lung Expansion
Drugs : Aspirin,Nutrofurantoin,Opiates,Cytokines
PS:Early post MI phase – acute decrease in miocardial compliance

4. Right Atrial Enlargement
PA CXR:
Prominent round superior border with SVC
> 5,5 cm from midline to most lateral RA margin
> 2,5 cm from right vertebral margin

5. Right Ventricular enlargement
PA CXR:
Upturned cadiac apex
Lateral CXR:
> 1/3 contact distance from cadiophrenic sulcus to sternal angle

6. Left Atrial Enlargement
PA CXR:
Retrocardiac double density
>75 % splaying of carina with horizontal orientation of left mainstem bronchus
Enlarged left convex left atrial appendage
> 7 cm from LMB to right LA border.
Lateral CXR:
Posterior displacement of Ba filled oesophagus

8. Left Ventricle Enlargement
PA CXR:
Downturned cardiac apex with leftward displacement
Left diaphragmatic inversion
Lateral CXR:
Posterior cardiac margin > 1,8 cm posterior to IVC meassured 2 cm above intersection of right hemidiaphragm with IVC.(Hofman-Rigler rule)

9. Cardiac vs Non Cardiac Oedema
Signs
Cardiac
Renal /Fluid Overload
ARDS
CARDIOMEGALY
(uremic pericarditis)
VASCULAR REDISTRIBUTION
Balanced
WIDENED VASCULAR PEDICLE
KERLEY LINES
PERIBRONCHIAL CUFFING
AIRSPACE OPACIFICATION
Basal
Central
Diffuse
PLEURAL EFFUSIONS
Very Common
Common

10. Congestive Cardiac Failiure

11. Stages of CCF Stage 1 PCWP 13-18 mmHg Redistribution Stage 2
Interstitial Oedema
Stage 3
PCWP > 25 mmHg
Alveolar Oedema

12. Redistribution/Cephalization

13. Redistribution

14. Interstitial Oedema

15. Interstitial Oedema

16. Interstitial Oedema

17. Alveolar Oedema

18. Alveolar Oedema

19. Gravity dependent density differences

20. Cardiothoracic Index

21. Pleural Effusion

22. Vascular Pedicle Width: < 60 mm, > 85mm , 5mm = 1l

23. VPW – Serial CXR

24. Azygos Vein Width : Erect > 10 mm , Supine > 15 mm , Serial X Rays > 3mm,Not depending on in - or expiration

25. Right Ventricular Failiure

26. References
1. assistant.nl – accessed 27/02/ Primer of Diagnostic Imaging – Fourth Edition 3.Radiology Review Manual – 6 th Edition