The Chest X-ray Still common In patient Portable imaging ‘Morning Portables’ Pre-op Post-op Out patient Still effective but possibly overused

Right Atrium Right Ventricle Left Ventricle Left Atrium The Chambers

The Pulmonary and Aortic Vessels Main Pulmonary Artery RDPA Main Pulmonary Artery LDPA Aortic Arch Descending Aorta

This Lecture Pulmonary Hypertension Ventricular Septal Defect Mitral Stenosis vs Mitral Regurgitation Aortic Stenosis

Pulmonary HTN Increase in pulmonary vascular resistance Mean pulmonary artery pressure (PAP) >25mmHg at rest At least 30 mmHg during exercise Mean pulmonary wedge pressure < 15mmHg

Causes Group 1 Idiopathic Pulmonary Arterial Hypertension Group 2 Left Heart Disease Pulmonary Venous Hypertension Group 3 Hypoxemia COPD Group 4 Group 5

Clinical Indications Dyspnea on exertion Dizziness Syncope Angina

Radiographic Indicators Prominent main pulmonary artery Convex shadow along the left cardiac border (PA) Right ventricle enlargement Increased cardiac border in contact with anterior chest wall (Lat) Right descending pulmonary enlargement Transverse diameter is greater than 16mm Pruning of peripheral pulmonary vessels Abrupt tapering of distal pulmonary vessels with loss of side branches Pleural effusion/Pulmonary Edema

Case courtesy of Dr Frank Gaillard, Radiopaedia.org Prominent Main Pulmonary Artery and Trunk Enlarged RDPA Pleural Effusion

ti=311759&searchkey= Enlarged Right Ventricle Enlarged Pulmonary Trunk

Miniati et al. Accuracy of chest radiography in predicting pulmonary hypertension: A case-control study. M. Miniati et al. / Thrombosis Research 133 (2014) 345–351

Ventricular Septal Defect Holes in the ventricular septum Conoventricular Perimembranous Inlet Muscular Most common congenital cardiac malformation Up to 50% in congenitally malformed hearts

Causes Can exist in isolation Or existing with other malformations: Tetralogy of Fallot Double outlet right ventricle Transposition Univentricular hearts

Clinical Indications Dependent on size May be asymptomatic May be cyanotic Retardation of growth Pulmonary HTN Pulmonary edema Wheezing Tachypnea

Radiographic Indicators Cardiomegaly Can be difficult to diagnose due to the thymus Increased pulmonary vascular markings

Normal Ventricular Septal Defect

Normal Cardiomegaly RADIOLOGIC CLINICS OF NORTH AMERICA VOLUME 37 * NUMBER 6 * NOVEMBER 1999

Ventricular Septal Defect septal-defect Case courtesy of Dr Frank Gaillard, Radiopaedia.org

Spicer et al. Orphanet Journal of Rare Diseases (2014) 9:144

Tetralogy of Fallot of Fallot Ventricular Septal Defect Right Ventricular outflow track obstruction Overriding Aorta Right Ventricular Hypertrophy Let’s Think What Happens

Mitral Stenosis Leaflet thickening resulting in narrowing of the mitral valve. Causes Rheumatic Fever Common in developing countries Degenerative Common in developed countries

Healthy Mitral Valve Mitral Valve Stenosis Fish Mouth Appearance

Mitral Regurgitation Systolic retrograde flow from the left ventricle into the left atrium. Causes Non-Ischemic Degenerative Endocarditis Rheumatic Ischemic

s/case9/figures.htm Healthy Mitral Valve disease/mitral-valve-disease/ Mitral Valve Prolapse

Clinical Indicators Dyspnea Exercise Intolerance Long Murmur Pulmonary HTN

Radiographic Indicators Left atrial enlargement Double Density Splayed Carina Decreased aortic knob

LA LV RV RA LA LV RVRA Double Density and Splayed Carina

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Aortic Stenosis Narrowing of the aortic valve. Causes: Age (Calcific AS, Senile) Similar to atherosclerosis Rheumatic Valve Congenital

Normal Aortic Valve Calcific Aortic Stenosis

Clinical Indicators Angina Syncope Heart Failure

Radiographic Indicators Aortic Valve Calcification Prominent Ascending Aorta Left Ventricular Enlargement

Ascending aorta projects farther than right atrium Normal Descending Aorta

Calcified Aortic Valve

Where are those valves? A M

A M

Aortic Valve

Mitral Valve

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