Cardiomegaly PDF

DR: Hassan Ibrahim.MD CARDIOMEGALY Lecturer of diagnostic and interventional radiology, Faculty of medicine, Suez university  Cardiomegaly Right ventricular enlargement ❑ The right ventricle is the most anterior cardiac chamber....

DR: Hassan Ibrahim.MD CARDIOMEGALY Lecturer of diagnostic and interventional radiology, Faculty of medicine, Suez university  Cardiomegaly Right ventricular enlargement ❑ The right ventricle is the most anterior cardiac chamber. ❑ Right ventricular enlargement causes displacement of the cardiac apex in a leftward direction (in contrast to left ventricular enlargement, which causes displacement in a left-inferior direction). RIGHT VENTRICULAR ENLARGEMENT  Cardiomegaly Right ventricular enlargement On lateral view, an enlarged right ventricle may result to (1)Retrosternal fullness. (2)The anterior cardiac border is in contact with greater than the lower 1/3 of the sternal length RIGHT VENTRICULAR ENLARGEMENT  Cardiomegaly Right atrial enlargement ❑ The right atrium forms the right heart border. ❑ Right atrial enlargement causes lateral bulging or elongation of the right heart border..  Cardiomegaly Right atrial enlargement The right atrial shadow (convexity in the lower half of the right mediastinal cardiovascular border) is usually: ▪ Not more than 50% of the cardiovascular height ▪ Not more than 5.5 cm from the midline RIGHT ATRIAL ENLARGEMENT RIGHT VENTRICULAR ENLARGEMENT  Cardiomegaly Left ventricular enlargement ❑ The left ventricle forms the left heart border. ❑ Left ventricular enlargement typically causes displacement of the cardiac apex in a left-inferior direction. LEFT VENTRICULAR ENLARGEMENT  LEFT VENTRICULAR ENLARGEMENT ON LATERAL VIEW, LEFT VENTRICULAR ENLARGEMENT MANIFESTS AS POSTERIOR DISPLACEMENT OF THE LEFT VENTRICULAR MARGIN. LEFT VENTRICULAR ENLARGEMENT ANNOTATED IMAGE SHOWING THE SHMOO SIGN FOR LEFT VENTRICULAR ENLARGEMENT. THE SHAPE OF THE SHMOO SUPERIMPOSED OVER THE RADIOGRAPH DEMONSTRATES THE ORIGIN OF THIS SIGN.  Cardiomegaly Left atrial enlargement ❑ The left atrium is the most posterior cardiac chamber. ❑ An enlarged left atrium may be caused by mitral regurgitation (with an enlarged cardiac silhouette) or mitral stenosis (with a normal cardiac silhouette). LEFT ATRIAL ENLARGEMENT  LEFT ATRIAL ENLARGEMENT DISTANCE OF THE RIGHT BORDER OF THE LEFT ATRIUM FROM THE MIDPOINT OF THE LEFT MAINSTEM BRONCHUS IS MORE THAN 7 CM LEFT ATRIAL ENLARGEMENT LEFT ATRIAL ENLARGEMENT LEFT ATRIAL ENLARGEMENT ATRIAL ESCAPE (THE RIGHT BORDER OF THE MARKEDLY ENLARGED LEFT ATRIUM GOES BEYOND THE RIGHT ATRIAL MARGIN)  Cardiomegaly Left atrial enlargement ❑ An enlarged left atrium can splay the carina, seen on the frontal view. ❑ On the lateral radiograph, an enlarged left atrium can elevate the left upper lobe bronchus.  Cardiomegaly Left atrial enlargement On lateral chest radiographs, an enlarged left atrium results to: ❑ Prominence of the upper posterior cardiac convexity ❑ Posterior displacement of the left mainstem bronchus (walking man sign) LEFT ATRIAL ENLARGEMENT LEFT ATRIAL ENLARGEMENT LEFT ATRIAL ENLARGEMENT  Cardiac diseases Right atrial enlargement: Plain radiograph Gross enlargement of the right atrial shadow, i.e. increased convexity in the lower half of the right cardiac border Right atrial convexity is more than 50% of the cardiovascular height Right atrial margin is more than 5.5 cm from the midline  Cardiac diseases Right ventricular enlargement Plain radiograph Rounded left heart border. Uplifted cardiac apex.  Cardiac diseases Left atrial enlargement Plain radiograph double density sign Oblique measurement of greater than 7 cm (from midpoint of left main bronchus to the right border of the left atrium. Convex left atrial appendage: normally the left heart border just below the pulmonary outflow track should be flat or slightly concave.  Cardiac diseases Others: 1-Splaying of the carina, with the increase of the tracheal bifurcation angle to over 90 degrees. 2-Superior displacement of the left main stem bronchus. 3-Posterior displacement of a barium-filled esophagus or nasogastric tube.  Cardiac diseases Left ventricular enlargement Plain radiograph Left ventricular dilatation: left heart border is displaced leftward, inferiorly and posteriorly. Left ventricular hypertrophy: may show rounding of the cardiac apex.