1. Radiological features of the Heart
Dr. Nivin Sharaf MD
LMCC

2. Objectives
This lecture will cover the ILO: Delineate the surface, and radiological anatomy of the heart
By the end of this lecture we should be able to:
Recognize the importance of the surface anatomy of the heart
Differentiate between PA and AP views of the heart
Recognize the different anatomical structures viewed in the AP/ PA and lateral views of the chest
Identify the anatomy of the chest on AP/PA and lateral chest x-rays. Describe how to position the patient for the PA and lateral chest x-rays. State what structures should be included on the PA and lateral chest radiographs.

3. Surface Anatomy

4. Surface Anatomy Cont.

5. Important points to remember
Apex: Left 5th intercostal space, mid clavicular line
Aortic
Pulmonary
Tricuspid
Mitral
“AParTment M”

6. Surface Anatomy Cont.

7. PA View 1. Chest radiograph PA projection
In a PA chest film of diagnostic quality the medial ends of the clavicles are equidistant from the spinous process of the adjacent thoracic vertebra. This indicates that it was taken with a truly sagittal X-ray beam. The hemidiaphragm should project at the level of the posterior portion of the tenth rib, or lower. This indicates that the exposure was made during deep inspiration.

8. PA View Cont.
In adults the heart and major vessels attached to it cast almost all of the mediastinal soft-tissue density shadow between the two radiolucent lung fields. (The vertebral column and sternum also contribute to the mediastinal shadow.) The right border of the mediastinum is composed of the following set of structures (listed from superior to inferior):
brachiocephalic artery and R. brachiocephalic vein superimposed
superior vena cava and aorta superimposed
R. atrium
inferior vena cava

9. PA View Cont.
The left border of the mediastinum is composed of the following set of structures (also listed from superior to inferior):
L. subclavian artery and L. brachiocephalic vein superimposed
posterior part of the aortic arch (the aortic knob)
pulmonary trunk
auricle of the L. atrium (atrial appendage)
L. ventricle
Even though the diaphragm is one continuous sheet of muscle it radiographs as two distinct hemidiaphragm silhouettes.

10. Notice the patient is standing!
Patient’s good condition
Gastric air bubble
Better quality

11. Positioning

12. Machine
Radiography involves exposing a part of the body to a small dose of radiation to produce an image of the internal organs. When x-rays penetrate the body, they are absorbed in varying amounts by different parts of the anatomy. The ribs and spine, for example, absorb much of the radiation and appear white or light gray on the image. Lung tissue absorbs little radiation and appears dark on the image. Depending upon the type of image recording medium, chest x-rays can be maintained as hard copy film for filing, or more commonly, as filmless digital images that are archived electronically. Digital images can also be transferred for storage onto CD-ROM. Stored images may be used to compare with later images if illness develops. Indeed, historical comparison films are often very important in the decision process as to whether a finding is clinically important or not.

14. FYI!

15. AP View Notice positioning” no centralization” Poor quality
Might have probes, drains, or wires as the patient is usually un ambulatory “ not able to move”

16. Portable X Ray Machine

17. Lateral View
In this view the tracheal lumen appears as an almost vertical radiolucent band which ends just behind the superior aspect of the posterior border of the cardiac shadow. The radiodensities of the two hila are superimposed at the inferior end of the trachea.
The radiolucent area bounded by the sternum anteriorly and the cardiac shadow and ascending aorta posteriorly is called the retrosternal area. The radiolucent area directly posterior to the lower part of the cardiac shadow is called the retrocardiac area.
As in the PA projection, the diaphragm images as two separate hemidiaphragms in the lateral projection.

20. References
atlas/Thorax/1chestra.html