CARDIAC AND MEDIASTINAL

IMAGING
Arief Iskandar, MD, Radiologist
Islana Gadis Yulidani, MD, Radiologist
Indrastuti Normahayu, MD, Radiologist
Dept. of Radiology
Saiful Anwar Hospital
MALANG
2011 1
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COR RADIOLOGY
Principle techique :
1. Convensional Radiography
2. Fluoroscopy
3. Cor Analysa
4. Cor Catetherisasi
5. Echocardiography
6. CT Scan dan Multislice CT
7. MRI
Radio isotop, Thalium test
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8.
RA LA

RV LV

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1. Conventional Radiology
2. Fluoroscopy
- Screening
- Motion
- PA
- Calsification
- Left lateral
- Pericard effusion
3. Cor Analysa :
- PA
- Lat Barium esophagography
- RAO
- LAO

4. Catheterisation
Evaluated - Chamber
- Great vessel
- Coronary artery
- Shunt
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- Valve
5. Echocardiography :
Ultrasound, B mode,M mode,colour doppler
- Valve
- Contractility
- Pericardial effusion
- Myocard
- Blood flow, vasculer pattency
6. Radioisotop
Evaluated of myocard
7. CT SCAN
8. MRI

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 RADIOGRAPHY TECHNIQUE :
- TELERADIOGRAPHY 1,8 – 2 M
- INSPIRATION
- STAND / SEAT

a. PA Projection :
- X-Ray from post or – ant or
b. b. Lateral Projection:
- Left
- True lateral
c. c. RAO Projection:
- < 45 – 60 0 , right shoulder
d. d. Projection LAO :
- < 60 – 70 0 , left shoulder
• Cor Anatomy Influenced by :
- Age
- Respiration

- Position

- Body shape

- Sternum / lung anomaly

Cor Radio anatomy

Fig. PA

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 Fig. Lat :

Fig RAO Fig LAO

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Fig : CTR A+B X 100 %
C1+C2

N : 45 – 50 %
Line A : 1/3 C1
B : 1/2 C2
D+E : < 4 cm
F : 1 – 2 cm
Abnormality Anatomy Ratio

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Caused of Cardiomegaly :
- Pericard anomaly
- Myocard anomaly

- Valve / Septum anomaly

- Trained people

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 RIGHT ATRIUM ENLARGED

PA - > 1/3 C1
- Phrenicocardialis enlarged
LAO - Right ventriculer angle & aorta
ascendens disappeared
RAO - Enlarged to the posteroinferior

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RIGHT VENTRICLE ENLARGED

Fig : PA Fig : LAT

Fig : RAO 13
 LEFT ATRIUM ENLARGED
PA : - To the left & right
- Right auricle prominent
- Double contour
RAO : - Oesophagus to the posterior
LAT : - Oesophagus to the posterior
on 1/3 medial
LAO : - Space under arcus aorta
narrowed

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 LEFT VENTRICLE ENLARGED
PA : - Enlarged to the left
- Apex downward
LAO : - Ventricle column covered by posterior interior cor
LAT : - RCS closed

Fig : PA Fig : LAO Fig : LAT

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Lung Vascular Pattern
- Cor anomaly changes of the vasculer pattern
- Lung anomaly cor alteration
- Lung vascular pattern :

. Normal :a-b=
. Decreased : a < b TF
. Increased : a > b ASD

Lung Vascularitation Pattern :

Cor diseases :
• Compensated
• Decompensated alterated lung vascular 18
Diseases:
- HHD
- Coronary arteria dis
- Cardiomyopathy
- Aortic Stenosis
- Coartatio aorta

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 LUNG VASCULARITATION
ARTERIAL

DECREASED INCREASED
 Right ventricle out flow 1. Shunt
vent obs pulmonal valve 2. PVO (Pulmonary Venous

Obst)
- Pulmonal stenosis 3. PAH (Pulmonary Arteri
- T.F Ht)
- Emboli A Pulmonalis 4. HOS (High Output State)

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 VENOUS

DECREASED INCREASED
- Depend on arterial condition - Venous congestion cause
pulmonary oedema and
pleural effusion

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• Shunt : • PVO MS
- Increased flow vascular Increased left atrial pressure

Enlarged great vascular

L to R shunt pada cor
- ASD •Cephalisasi
- VSD
Great vascular Odema Interstitial
- PDA
Kerley B line

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 PAH
- Central vasculer flow enlarged → narrowed
- Inverted coma sign ( central type )
-Dilated of hilar ( peripheral type )
example :
Severe lung diseases
Lung emboly
VSD,ASD ( late phase )

HOS :
- Increase blood volume

Increased vascularitation
- Severe anemis
- Thyrotoxicosis
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Cor anomaly:
- Acquired Heart Diseases
- Heart Diseases Position
- Myocardial anomaly
- Cor pulmonale
- Congenital Heart Diseases
- Pericardial anomaly
- Aorta anomaly

Inflammation:
Valve
- Coccus Valve ring
- Lues M. Papillaris
Myocard
Pericardium 24
Mitral - Stenosis
- e.c Endocarditis
- Hypertrophy & dilation left atrium caused by narrowed mitral valve

- Increased left atrium pressure

- Pulmonal vein congestion

-Capilary resistency » lung

- Blood flow resistency from right ventricle

- Increased pressure

- Enlarged right ventricle

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 Radiologic Pattern :
PA :
- Double contour + - Enlarged Left Auricle atrium
- Aorta normal / decreases - Prominent conus pulmonalis
- Apex upward

Mitral Configuration:
- Lung alteration:
Cephalization

Lung edema

Kerley B lines

Pleural effusion
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Mitral Insufisiensi (MI)

- Blood flow from left ventricle to left atrium on sistole state →

regurgitation

- Enlarged left atrium

- Diastole blood flow from left atrium to left ventricle>>

- Enlarged left ventricle

- Sistole enlarged pulmonal vein

- Diastole normal flow left atrium to left ventricle

Congestion-
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Radiologic Pattern:
- Oesophagus to the right
- Enlarged heart to the left,apex down ward
- Normal hilar
DD :
• VSD Enlarged hilar
a. Enlarged pulmonal artery

MS & MI Combination
- Enlarged left ventricle
- Enlarged right ventricle
- Bulge pulmonal segmen
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Aorta Insuficiensi (AI)

- Diastole : back flow blood from aorta to left ventricle Left

ventricle enlarged
- Sistole blood pump left ventricle enlarged

Aorta enlarged

Radiologic Pattern :

PA : - Enlarged heart, apex down ward

- Bulge arcus aorta
- Heart waist convex

Aorta configuration
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Aorta Stenosis (AS)

- Narrowed aorta valve

- Increased pressure from left ventricle

Aorta ascendens wall pressured

Enlarged

- Heart enlarged to the left

- Apex downward
- Normal arcus aorta
- Enlarged aorta ascendens

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 Congenital Heart Diseases With Increased
Lung Vascular Pattern

Non Cyanotic Cyanotic

- ASD - TAPVR
- VSD - Truncus arteriosus persisten
- PDA - Great vascular transposition
- PAPVR (Partial Anomalous Pulmonary

Venous Return)

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 Atrial Septal Defect (ASD)
Hemodinamika : Radiologic Pattern :
PA - Heart enlarged to the left, apex
VP
upward
- Prominent hilar
- Enlarged pulmonal arterx
RA LA
Paru - Enlarged pulmonal vein
RV LV
- Narrowed arcus aorta
LAT - Enlarged right ventricle

AP AO

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Ventricular Septal Defect (VSD)
VP

RA LA
Paru

RV LV

AO
AP

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 Patent Ductus Arteriosis (PDA)

RA LA
RA LA
Paru
Paru
RV LV
RV LV

AP AO
PDA
PDA

Radiologic Pattern :
- Arcus aorta & conus pulmonalis bulge bulbus sign
- Enlarged lung vascular
- Enlarged left atrium
- Enlarged right ventricle 37
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Congenital Heart Diseases With Decreased Lung Vascular Pattern.

Non Cyanotic :
Pulmonal stenosis :
- Pulmonal stenosis valve
- Infundibular stenosis
- Stenosis above valve in main brand pulmonal artery
Fig :

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Cyanotic :

- Tetralogy fallot
- Trilogy fallot
- Pulmonal atresia
- Tricuspidal atresia
- Ebstein disease

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 Tetralogi Fallot :

RA LA
- Pulmonal stenosis type
Infundibular / valvular
RV LV - VSD : L R shunt
- Semitransposition aorta
- Right vent hypertrophy

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HEART POSITION ANOMALY

- Dextrocardia : - Dextroversi :
. At right hemithorax . At right hemithorax
. Aorta & apex at the right . Situs inversus -
. Situs invertus

- Mesoversi Minimal turn the left

- Levocardia Situs inversus

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