Comprehensive Guide to Cardiovascular Imaging and Anatomy

CARDIOVASCULAR IMAGING
 
 
Radiological Anatomy of the Chest 
Radiological Anatomy of the Chest 
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Pulmonary artery
 
 
Pulmonary embolism
Pulmonary embolism
THE GOLD STANDARD FOR
DIAGNOSIS OF PE IS 
CTA 
 
CTA PULMONARY VASCULATURE
CTA PULMONARY VASCULATURE
CTA
(Coronal Reconstruction)
NORMAL
NORMAL
HOMOGENOUS FILLING
HOMOGENOUS FILLING
OF THE VESSLES
OF THE VESSLES
CT Agiogram
AORTIC ARCH ANATOMY
The Aortic arch/great vessels
“Man’s Anatomy by Tobias & Arnold
Aortic aneurysm
Aortic knob/knuckle
Aortic knob/knuckle
Cardiomegaly plus early Congestive Heart
Failure (CHF)
Key:
1.
Inferior vena cava (IVC)
2.
Superior vena cava (SVC)
*3.
 
Azygos vein
4.
Carina
5.
Trachea
6.
Right main stem bronchus
7.
Prominent pulmonary vessels
Heart and Vessels
Any and or all heart chambers may enlarge when the
heart becomes diseased. Cardiomegaly = a big heart.
A patient’s heart enlarges due to a number of diseases
e.g. valve disease, high blood pressure, congestive
heart failure.
If the heart fails, the lung often become congested.
Early on the pulmonary vessels appear more
prominent as in this case. More advanced failure can
result in a condition of pulmonary edema which is
fluid flooding into the alveoli of the lungs causing
the patient marked shortness of breath.
2
7
7
7
7
5
4
3
1
 
Cardio-thoracic
Cardio-thoracic
Ratio
Ratio
 
<50%
 
Sometimes, CTR is more than 50%
But Heart is Normal
 
 
Extracardiac causes of cardiac
enlargement
Portable AP films
Obesity
Pregnant
Ascites
Straight back syndrome
Pectus excavatum
 
>50%
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.
 
Obstruction to outflow of the ventricles
Ventricular hypertrophy
Must look at cardiac contours
 
Sometimes, CTR is less than 50%
But Heart is Abnormal
 
<50%
Anatomy on Normal Chest X-Ray
Heart borders and chambers of the heart on PA and lateral views.
The Cardiac Contours
 
There are 7 contours to the heart in the
 frontal projection in this system
.
The Cardiac Contours
But only the top five are really important
in making a diagnosis.
 
Low density,
almost straight
edge
represents size
of ascending aorta
Ascending Aorta
Small
Prominent
Ascending Aorta
 
42mm
 
Enlarged with:
l
 Increased pressure
l
 Increased flow
l
 Changes in aortic wall
Aortic Knob
Main
Pulmonary
Artery
The next bump down is the main
pulmonary artery and is the
keystone of this system.
Finding the
Main
Pulmonary
Artery
 
Adjacent to left
pulmonary artery
Finding the
Main
Pulmonary
Artery
We can measure the main pulmonary artery  . . .
 
Concavity where L
atrium will appear on
left side when enlarged
Left atrial enlargement
The Pulmonary
The Pulmonary
Vasculature
Vasculature
Five States of the Pulmonary
Vasculature
 
Normal
Pulmonary venous hypertension
Pulmonary arterial hypertension
Increased flow
Decreased flow
What to Evaluate
What to Evaluate
2. Normal Distribution of Flow
Upper Versus Lower Lobes
 
Size of
vessels at
bases is
normally
> than size
of vessels
at apex
You can’t measure size of
vessels at the left base because
the heart obscures them
 
Normal
tapering of
vessels from
central to
peripheral
 
Central vessels
give rise to
progressively
smaller peripheral
branches
3. Normal Distribution of Flow
Central versus peripheral
Normal Vasculature - review
 
RDPA
< 17 mm in
diameter
 
Lower lobe
vessels larger
than upper
lobe vessels
 
Gradual
tapering of
vessels from
central to
peripheral
 
RDPA usually
 > 17 mm
 
Upper lobe
vessels equal
to or larger
than size of
lower lobe
vessels =
Cephalization
Venous Hypertension
The Pulmonary Vasculature
 
l
Normal
l
Pulmonary venous hypertension
l
Pulmonary arterial hypertension
l
Increased flow
l
Decreased flow - mostly
unrecognizable even when it is
present
CHF
ACUTE PULMONARY EDEMA
CLEARED APE
KERELY’S B-LINES
CARDIAC CT
FOR THE HEART AND CRONARY VESSLES
 
PERICARDIUM
MYOCARDIUM
CONTRAST
PERICARDIUM
CONTRAST
SEPTUM
AXIAL
SAGITTAL
 
CARDIAC CHAMBERS
Maximum Intensity Projection
Soft Plaque in Proximal LAD
PLAQUE
NORMAL
NARROWED
LUMEN
PLAQUE = VASCULAR NARROWING
STENT
STENT
Soft
 Plaque Visualization
CTA                                   CATHETER ANGIOGRAPHY
CALCIFIC PLAQUES
CORONARY ARTERIES
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Explore a detailed collection of images showcasing cardiovascular imaging, radiological anatomy of the chest, vascular anatomy, and pulmonary conditions like embolism. Discover the gold standard for diagnosing pulmonary embolism, as well as CT angiograms and aortic arch anatomy. Engage with visuals illustrating aortic aneurysms, heart and vessels, and more in this informative resource.


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  1. CARDIOVASCULAR IMAGING

  2. Radiological Anatomy of the Chest Lung Window Sagittal Axial Coronal Mediastinal Window

  3. Vascular anatomy of the chest

  4. Vascular anatomy of the chest

  5. Vascular anatomy of the chest

  6. Pulmonary artery

  7. Pulmonary embolism

  8. Pulmonary embolism

  9. THE GOLD STANDARD FOR DIAGNOSIS OF PE IS CTA

  10. CTA PULMONARY VASCULATURE

  11. CTA (Coronal Reconstruction) Embolus in left main pulmonary artery Embolus in descending right pulmonary artery NORMAL HOMOGENOUS FILLING OF THE VESSLES

  12. CT Agiogram

  13. AORTIC ARCH ANATOMY KKUH

  14. The Aortic arch/great vessels Man s Anatomy by Tobias & Arnold

  15. Aortic aneurysm Aortic knob/knuckle

  16. Heart and Vessels Cardiomegaly plus early Congestive Heart Failure (CHF) Key: 1. Inferior vena cava (IVC) 2. Superior vena cava (SVC) *3. Azygos vein 4. Carina 5 7 7 7 7 2 5. Trachea 4 6. Right main stem bronchus 3 7. Prominent pulmonary vessels Any and or all heart chambers may enlarge when the heart becomes diseased. Cardiomegaly = a big heart. A patient s heart enlarges due to a number of diseases e.g. valve disease, high blood pressure, congestive heart failure. If the heart fails, the lung often become congested. Early on the pulmonary vessels appear more prominent as in this case. More advanced failure can result in a condition of pulmonary edema which is fluid flooding into the alveoli of the lungs causing the patient marked shortness of breath. 1

  17. One of the easiest observations to make is something you already know: the cardio-thoracic ratio which is the widest diameter of the heart compared to the widest internal diameter of the rib cage Cardio-thoracic Ratio <50%

  18. Sometimes, CTR is more than 50% But Heart is Normal Extracardiac causes of cardiac enlargement Portable AP films Obesity Pregnant Ascites Straight back syndrome Pectus excavatum

  19. >50% 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.

  20. Sometimes, CTR is less than 50% But Heart is Abnormal Obstruction to outflow of the ventricles Ventricular hypertrophy Must look at cardiac contours

  21. <50% Here is an example of a heart which is less than 50% of the CTR in which the heart is still abnormal. This is recognizable because there is an abnormal contour to the heart (arrows).

  22. Anatomy on Normal Chest X-Ray Heart borders and chambers of the heart on PA and lateral views.

  23. The Cardiac Contours Aortic knob Ascending Aorta Main pulmonary artery Double density of LA enlargement Indentation for LA Right atrium Left ventricle There are 7 contours to the heart in the frontal projection in this system.

  24. The Cardiac Contours Aortic knob Ascending Aorta Main pulmonary artery Double density of LA enlargement Indentation for LA Right atrium Left ventricle But only the top five are really important in making a diagnosis.

  25. Ascending Aorta Low density, almost straight edge represents size of ascending aorta

  26. Ascending Aorta Prominent Small

  27. Aortic Knob 42mm Enlarged with: Increased pressure Increased flow Changes in aortic wall

  28. Main Pulmonary Artery Important The next bump down is the main pulmonary artery and is the keystone of this system.

  29. Finding the Main Pulmonary Artery

  30. Finding the Main Pulmonary Artery Adjacent to left pulmonary artery We can measure the main pulmonary artery . . .

  31. Left atrial enlargement Concavity where L atrium will appear on left side when enlarged

  32. The Pulmonary Vasculature

  33. Five States of the Pulmonary Vasculature Normal Pulmonary venous hypertension Pulmonary arterial hypertension Increased flow Decreased flow

  34. What to Evaluate 2 1 2 3

  35. 2. Normal Distribution of Flow Upper Versus Lower Lobes In erect position, blood flow to bases > than flow to apices Size of vessels at bases is normally > than size of vessels at apex You can t measure size of vessels at the left base because the heart obscures them

  36. 3. Normal Distribution of Flow Central versus peripheral Central vessels give rise to progressively smaller peripheral branches Normal tapering of vessels from central to peripheral

  37. Normal Vasculature - review 2 RDPA < 17 mm in diameter Gradual tapering of vessels from central to peripheral 1 3 Lower lobe vessels larger than upper lobe vessels 2

  38. Venous Hypertension RDPA usually > 17 mm Upper lobe vessels equal to or larger than size of lower lobe vessels = Cephalization

  39. The Pulmonary Vasculature Normal Pulmonary venous hypertension Pulmonary arterial hypertension Increased flow Decreased flow - mostly unrecognizable even when it is present

  40. CHF KKUH

  41. ACUTE PULMONARY EDEMA

  42. CLEARED APE

  43. KERELYS B-LINES

  44. CARDIAC CT FOR THE HEART AND CRONARY VESSLES

  45. PERICARDIUM PERICARDIUM AXIAL SAGITTAL SEPTUM CONTRAST CONTRAST MYOCARDIUM

  46. CARDIAC CHAMBERS

  47. Maximum Intensity Projection Soft Plaque in Proximal LAD PLAQUE NORMAL NARROWED LUMEN

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