Radiographic Pathology Lecture 6

Radiographic Pathology - Learning Objectives

• Identify common cardiovascular system pathologies
• Demonstrate the pathological characteristics of CVS on radiographic appearances

Lecture 6 - Cardiovascular System

• This lecture covers the cardiovascular system.

Recap - Anatomy

• Diagrams of the heart and relevant anatomical components are presented, including:
  • SVC (Superior Vena Cava)
  • RA (Right Atrium)
  • RV (Right Ventricle)
  • LV (Left Ventricle)
  • Aortic arch
  • Pulmonary trunk
  • Left atrial appendage
  • Cardiac apex (LV)

Normal Cardiac Contours

• The left heart contour represents the left lateral border of the left ventricle (LV).
• The right heart contour represents the right lateral border of the right atrium (RA).

Heart Assessment

• The heart is assessed using the cardio-thoracic ratio (CTR), calculated by dividing cardiac width by thoracic width.
• Measurements of heart size must be below 50% of the total thoracic diameter for a normal CTR.
• A cardiomegaly condition occurs when CTR exceeds 50%.

Heart Component Analysis

• The hemidiaphragms do not indicate the lowest point of the lungs.
• A comprehensive analysis of cardiovascular structures, including the heart, is vital for accurate radiographic interpretation.

Congenital and Hereditary Cardiovascular Diseases

• Dextrocardia: The heart is positioned on the right side of the chest instead of the left, a congenital condition. Typically, no significant symptoms occur.

  • The diagnosis could involve ECG or imaging (CXR).

• Septal Defect: A hole in the ventricular or atrial septum allows blood flow between the two chambers.

  • Diagnosis using echocardiography is preferred, alongside CXR.
  • The left atrium and ventricle are usually enlarged in cases of septal defect.
  • Pulmonary vascular markings and pleural effusions might also be present.
  • Treatment may involve surgical intervention.

• Coronary Artery Disease (CAD): Atherosclerosis causes the arteries supplying the heart to become clogged with plaques or atheroma (fibrofatty plaques).

  • It is diagnosed using angiography, CT angio, MRI, or Doppler US.
  • Slow narrowing can allow collateral vessels to form, which maintain blood supply.
  • Treatments frequently involve medication and catheterization procedures.

Coronary Artery Disease (CAD) continued

• CAD is a major cause of death in the United States.
• Diagnosis uses MRI, CT, nuclear medicine, and angiography.
• Treatment involves medications, catheterization procedures, or bypass grafts.

Myocardial Infarction (MI)

• MI occurs when blood supply to the heart muscle is blocked.
• Symptoms include chest pain radiating to the neck, left arm, shortness of breath, sweating, and nausea.
• Cardiac angiography (or catheterization) is critical for diagnosing and treating MI.

Aneurysms

• Aneurysms are vascular wall dilatations caused by atherosclerosis, trauma, an infection, or a congenital anomaly.
• Rupture often results in immediate mortality.
• Diagnosis by CT, MRI, and ultrasonography determines aneurysm size and extent.
• Treatment involves using clips, stents, or coils.

Venous Thrombosis

• Venous thrombosis involves blood clot formation within a vein.
• These clots commonly occur in the lower extremities, potentially leading to blood flow restrictions and requiring postoperative and bedfast patients to monitor.
• Diagnosis might involve US or venography.
• Treatment typically utilizes anticoagulant or thrombolytic therapy.

Pulmonary Embolism (PE)

• PE occurs when a clot becomes lodged in the pulmonary artery, often migrating from the lower extremities.
• Symptoms include respiratory distress, heart failure, or cardiogenic shock.
• Diagnosing PE involves ventilation perfusion scanning, CT, or angiography.
• Treatment consists of thrombolytic therapy (e.g., tPA) or blood thinners.

Congestive Heart Failure

• Congestive heart failure is a long-term condition where the heart's pumping ability is inadequate, leading to fluid accumulation in lungs and extremities.
• Symptoms include shortness of breath, fatigue, leg swelling, irregular heartbeat, wheezing, and chronic cough.
• Diagnoses often use CXR, echocardiograms and ECG.
• Radiographically, the heart appears enlarged, pleural effusion is prevalent, and pulmonary vascular markings are significant.

Additional Information

• Dextrocardia is diagnosable as a congenital and hereditary condition, while venous thrombosis commonly affects lower extremities via superficial veins.
• Ischemia relates to local, temporary blood circulation impairment.