Prof. Dr. H.M. Arief Gella, Sp.Rad(K) Dr. Andi Darwis, Sp.

Rad

Cardiac Anatomy

Cardiac Size

The methods in assessment of

cardiac enlargement is by measuring the CTR (cardiothoracic ratio)

CTR should not exceed 50% CTR increased in the elderly CTR may be increased in the neonate

Cardiac Size

Here is a heart that is larger than 50% of the cardiothoracic ratio, but it is still a normal heart. This is because there is an extracardiac cause for the apparent cardiomegaly. On the lateral film, the arrows point to the inward displacement of the lower sternum in a pectus excavatum deformity.

Here is an example of a heart that is less than 50% of the CTR, but the heart is abnormal. This is recognizable because there is an abnormality of the heart contour (yellow arrows).

Right ventricular enlargement

Left ventricular enlargement

Five States of The Pulmonary Vasculature

Normal
Pulmonary venous hypertension Pulmonary arterial hypertension Increased flow Decreased flow

What Were Going to Evaluate

1.
2.

Right descending pulmonary artery

Distribution of flow in the lung

Upper versus lower lobes

Central versus peripheral

The Pulmonary Vasculature

Review

Normal
Pulmonary venous hypertension Pulmonary arterial hypertension Increased flow Decreased flow mostly unrecognizable even when it is present

Tetralogy of Fallot: Classic Findings

A. Coeur en sabot with characteristic elevation of the apex is seen [black arrow]. The cardiac waist is

narrow [long white arrow] because of the absence of poststenotic pulmonary artery dilatation.
The pulmonary vasculature is decreased, and the aortic knob is prominent [short white arrow]. B. Lateral view demonstrates the prominent right ventricle [arrow]

Cyanotic Newborn

ASD

VSD

PDA

Severe PAH 2 ASD

Mitral Stenosis

Combined MS & MI

Aortic Stenosis

Aortic Insufficiency

Combined AS & AI

Hypertensive Heart Disease (HHD

Cor Pulmonale and Pulmonary Hypertension

The main pulmonary artery segment [arrowhead] is dilated, and the peripheral vessels [arrows] are narrowed in a patient with longstanding emphysema. Enlargement of the right heart is seen most clearly on lateral view.

Early Congestive Heart Failure

Acute intraalveolar pulmonary edema in patient with left heart failure. Note the central distribution of edema fluid batwing appearance in the upper and lower zone of the lung.

Ballooning
C

Stenting