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Cardiac ImagingCardiac Position and Sinus
Cardiac Positions Levocardia: the heart is predominantly in the left chest,
the cardiac apex points leftward Dextrocardia: the heart is predominantly in the right
chest, and the cardiac apex points rightward Mesocardia: the heart is positioned in the midline, and the
cardiac apex points directly inferiorly Dextroposition (dextroversion): the cardia apex points
leftward, but the heart is located predominantly in the right chest (typically due to extrinsic forces)
Visceroatrial Situs “SITUS” refers to the pattern of anatomic arrangement Atrial situs is usually concordant with visceral situs; hence,
these two are described together Situs solitus
o The morphologic right atrium is to the right of the morphologic left atrium
o The gastric air bubbles is on the left side and the liver on the right
Situs inversuso The morphologic right atrium is to the left of the
morphologic left atriumo The gastric air bubbles is on the right side, and
the liver is on the left Situs ambiguous
This term is used when identification of visceroatrial situs is not possible due to paucity
of anatomic markers
Dextrocardia Sinus solitus
Dextrocardia Sinus inversus
Situs Ambiguous
Cardiac SizeCardio-Thoracic Ratio: divide the widest transverse diameter
of the heart by the widest transverse diameter of the thorax taken at the inner side of the rib cage
Chamber Enlargement
Right Atrial Enlargemento lateral bulging of the right
heart bordero elongation of the right
heart border (length of right heart border exceeds 50% of the mediastinal cardiovascular shadow)
Right Ventricular Enlargemento PA View : Rounding
and upliftment of cardiac apex
o Lateral View : Retrosternal fullness (contact of anterior cardiac border greater than 1/3 of the sternal length)
Left Atrial Enlargement
NOTES: In Dextrocardia, gastric bubbles is on the right side
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o PA view : Double density
o PA view : Enlargement of LA appendage
o PA view : Upliftment of left mainstem bronchus
o Lateral View : - Prominent posterosuperior cardiac border- Posterior displacement and upliftment of
left mainstem bronchus
Left Ventricular Enlargemento PA view : lateral
and downward displacement of the cardiac apex
o Lateral View : - Posterior
displacement
of the posterior inferior border of the heart
- Hoffman-Rigler Sign: measured 2 cm above the intersection of the diaphragm & IVC; (+) if posterior border extends more than 1.8 cm of IVC
Pulmonary Vascular Pattern
Comparison of Normal and Increased
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Lateral View
Comparison of Normal and Decreased
Lateral View
Venous Congestion
Increased Arterial Blood Flow
Kerley’s B lines
Perihalar Haziness
Peribronchial Cuffing
Redistribution Equalization
Redistribution Cephalization
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Interstitial Edema
The Great Arteries Aorta
o Normal
o Prominento Diminutive
Main pulmonary arteryo Normal
o Prominent
o concave
Conditions wherein pulmonary artery is concave: Transposition of great arteries TOF Pulmonary atresia
Congenital Heart Diseases Anatomic malformation of the
heart and or its vessels, which occurs during the intrauterine development
Radiologic Interpretation of congenital heart disease1. Cyanotic or acyanotic2. Vascularity: normal, increased, or decreased
Non-cyanotic ASD (RAE and RVE) VSD (both ventricles may
be enlarged and LA) PDA (LVE & LAE) AV canal defect
Increased Vascularity
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Ventricular Septal Defect Increased vascularity Normal or enlarged cardiac
size Chamber prominence:
o Either or both ventricles
o Left atrium Enlarged main and central
pulmonary arteries Normal or small aorta
VSD:
Patent Ductus Arteriosus Increased vascularity Normal or enlarged cardiac
size Chamber prominence: Left ventricle Left atrium Enlarged main and central
pulmonary arteries Prominent aortic knob
Atrial Septal Defect
Increased vascularity Cardiomegaly Chamber prominence:
o Right atriumo Right
ventricle Enlarged main and
central pulmonary arteries
Small aortic knob
Transposition of the Great Arteries (d-TGA) Increased vascularity Cardiomegaly Cardiac silhouette:
o “Egg on its side”o “Apple on a stem”
Narrow vascular pedicle
Patent Truncus Arteriosus Increased vascularity Pulmonary venous
congestion or edema is frequent in Type 1
Cardiomegaly Chamber prominence
o Either or both ventricles
o Left atrium Concave main pulmonary
artery segment (Prominent in Type 1)
Total Anomalous Pulmonary Venous Return Increased vascularity Cardiomegaly Chamber prominence
o Right atriumo Right ventricle
Enlarged systemic vein into which drainage occurs
Type 1 (Supracardiac)o left-sided vertical
vein connects pulmo venous confluence to the left innominate vein, right SVC or azygos vein
o “Snowman appearance” Type III (Infracardiac)
o Connection is below the diaphragm to the portal vein, ductus venousus or hepatic vein
o Pulmonary edemao Normal sized heart
Cyanotic dTGA TAPVR without
obstruction PTA Single ventricle DORV without pulmo
stenosis
Decreased Vascularity Normal Vascularity
Coarctation of the aorta Aortic stenosis Pulmonary stenosis
TOF Ebstein’s anomaly Severe pulmo stenosis Pulmo Atresia Tricuspid atresia with
pulmo stenosis DORV with pulmo
stenosis
Increased Venous Vascularity
Hypoplastic left heart Pulmonary vein stenosis TAPVR with obstruction
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o Prominence of the right atrium and less often the right ventricle
Tetralogy of Fallot Depressed vasularity Normal or enlarged
cardiac size Right ventricular
prominence Concave main
pulmonary artery segment
Prominent aorta Right aortic arch (in 20-
25%) Boot-shaped heart
Pulmonary Stenosis Normal to decreased
vascularity Normal or enlarged cardiac
size Right ventricular
prominence Post-stenotic dilatation of
the main pulmonary artery
Ebstein’s Anomaly Decreased vascularity Marked cardiomegaly Right atrial prominence “Balloon-“ or “box-
shaped”
Aortic Stenosis Normal vascularity Cardiomegaly Left ventricular prominence Dilated ascending aorta
Coarctation of the Aorta
Normal vascularity Cardiomegaly Left ventricular prominence “3” sign
Mitral Stenosis Normal to slightly enlarged heart Chamber prominence:
o Left atriumo Right ventricle
Equalization or cephalization of pulmonary blood flow
Prominent main pulmonary artery segment
Small aorta
Mitral Regurgitation Cardiomegaly Chamber prominence
o Left atrium (MR > MS)o Left ventricle
Pulmonary venous congestion (MR < MS)
Small aorta
Aortic Stenosis Normal-sized heart or mild
cardiomegaly Left ventricular
hypertrophy +/- pulmonary venous
hypertension Dilated ascending aorta
Aortic Regurgitation Cardiomegaly Left ventricular
enlargement Dilated ascending aorta
and aortic arch Normal pulmonay
vascularity
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