RADIO DIAGNOSTIK JANTUNG

dr. Sri Mulyati Noer, Sp.Rad

Cardiac Roentgen Examination

PA Position

Cardiac Roentgen Examination

RAO Position

Cardiac Roentgen Examination

LAO Position

Cardiac Roentgen Examination

Lateral Position

Cardio Thoracic Ratio

• Line XY : is drawn which bisects the thoracic spine ( lies over the spinous processes): midline

• TR & TL : the maximum perpendicular projections of the right and left cardiac borders from the

midline • TR plus TL : the “ greaterst tranverse diameter “ of the

heart• GTL : Tranverse diameter of the both thoraxic wall : the

greatest transverse line of the both thoraxic wall • Cardio Thoraxic Ratio : TR + TL x 100 %

GTL

TR

TL

CTR = TR + TL X 100%GTL

GTL

XL

RIGHT ATRIAL ENLARGEMENT

LEFT ATRIAL ENLARGEMENT

LEFT ATRIAL ENLARGEMENT

RIGHT VENTRICLE ENLARGEMENT

RIGHT VENTRICLE ENLARGEMENT

Hypertensive Heart Configuration

• Elongated aorta - Normal : Distance between top of manubrium to top of aorta > 1cm - Elongated aorta : < 1 cm

• Calcifikasi arcus aorta • LVH

The diaphragm is elevated

LEFT VENTRICLE ENLARGEMENT

LEFT VENTRICLE ENLARGEMENT

Hypertensive Heart Configuration

Chest X Ray Appearance of Left Heart Failure Early Left ventricular decompensation

Chronic Passive Congestion of the lung : - Apical portion relatively clear - Prominent pulmonary veins in upper lung fields ( left supra hilar) ( normal lung : the upper lobe arteries and veins are smaller than in the lower

lobes ) - In the upper zone of the lung : dilatation of the pulmonary veins , whereas

the pulmonary arteries dilate only slightly - In the lower zone paradoxically : the veins and arteries are not dilated

Left heart failure : 1. Enlarged and dilated heart : left heart enlargement2. Increased pulmonary interstitial density with cluoding of the lung3. Loss of sharp of blood vessels 4. The Septal lines in the lungs and thickened fissures due to sub pleural collection of fluid : Kirley A and Kirley B

Advanced progressive cardiac failure : intra alveolar edema is usually associated with the typical butterfly wing distribution of the intra alveolar fluid

Pulmonary Venous Hypertension • Prominent pulmonary veins in upper lung fields • Dilated veins in hili ( hilar hizy)• Perivascular and peri bronchial cuffing• Kirley’s A and B lines • Perivascular haziness• Reticulations of pattern in lower lobes• Loss of tranlucency in lung bases

Interstitial Pulmonary OedemaPulmonary Venous Hypertension

Kerley B

Pulmonary Arterial Hypertension 1. Pulmonary of arteries near hili enlarged ,

particularly more so in upper lobe • Right pulmonary artery enlarges : reverse comma / inverted

comma sign • Left pulmonary artery enlarges : large knob below aortic

knob

2. Narrowing of pulmonary arteries in lower lobes 3. Tortuosity of smaller pulmomary arteries

• Normally the measurement of the pulmonary artery is less than 15 mm

Mitral Stenosis

• Left Atrial enlargement :1. Left atrium bulges posteriorly ( posisi RAO ) , oesophagus displaced posteriorly to right (LAO with barium contrast ) ; double contoured appearance on right border due to large left atrium extending to right , ( PA ) 2. Left bronchus upward3. Loss of aortic incisura , heart rotates to left 4. Incresed distention of pulmonary veins

Mitral Insufficiency

• Left ventricle enlarged to left • Left Atrium enlargement• Enlarged pulmonary arteries, until right heart failure• Small aorta

Atrial Septal Defect • Right Ventricular enlargement (lateral view)

• Normal : Right ventricle one third lower of mediastinal clear space (retromediastinal space)

• Right ventricle hypertrophy > one third lower of mediastinal clear space (right ventricle tends to enlarge upward encroachment upon the anterior superior mediastinal clear space)

• Increase convexity in left pulmonary sector• Outflow right ventricle >> pulmonal arterial hypertension :

• Diameter of pulmonal artery (right hillus) > 1,5cm• Inverted comma sign

Ventricular Septal Defect

• Right Ventricular enlargement • Inverted comma sign

Pericardial Effusion

Patent Ductus Arteriosus

• The ductus arteriosus is a short arterial connection between the distal portion of the arch of the aorta and the pulmonary artery near its bifurcation . Normally , the ductus closes during the first week of life . When there is a percistence of a patent ductus, and if the aortic pressure remains higher than that in the pulmonary circulation , the flow is from the arch of the aorta through the ductus into the pulmonary circulation

Patent Ductus Arteriosus

Radiographycally appearance : • When larged amounts of blood are shunted through the

ductus , the pulmonary artery is enlarged and bulges from the left cardio pericardial silhouette beneath the aortic knob.

• The aortic knob also is unduly prominent• The left ventricle becomes enlarged with some

enlargement also in the region of the left atrium • The marked pulmonary arteries have been described

as a “ hilar dance “

Cardiomyopathy

• Pembesaran jantung ke kanan dan ke kiri sebagai cor bovinum• Bisa merupakan right and left heart failure

oedema pulmonum, batwing appereance, kadang-kadang ada gambaran myocardial aneurysm : circumscribed bulging pada dinding jantung

Myocardia Aneurysm

Alveolar Pulmonary Oedema

• The radiographic changes in association with alveolar pulmonary oedema

• Heart enlarged• Coarse fluffy nodular shadows troughtout inner and middle 1/3 zones• Clear periferal zones• Distended pulmonary vessells and lymphatics

Alveolar Pulmonary Oedema• Ringan : Interstitially pulmonary oedema : hypertensi v pulmonalis.

Causa kelainan jantung : over load atrium kiriThorax PA :

• cephalisasi : delatasi v pulmonalis didaerah supra hilar • Peri bronchial dan peri vascular cuffing : perselubungan sekitar cabang-2

bronchus dan vascular dihilus ( hilar hazy)• Dapat ada effusion : perselubungan sinus phrenico costalis• Kerley A, Kerley B

• Berat : alveolar oedema Bat-wing appearance atau Butterfly appearance Causa : 1. kelainan jantung decompensatio cordis

2. Uraemia : uraemic lung Thorax PA : perselubungan symetris dengan perselubungan tebal mulai disentral , kemudian makin keperifer makin menipis

Alveolar EdemaButterfly Appereance

Alveolar Pulmonary Oedema

• Patholgically : the alveoli and interstitium become filled with a transudate. The transudate may develop acutely or gradually and like wise may remain for variable periods of time