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Diagnosis of heart diseases from chest x ray

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The condition of your lungs. Chest X-rays can detect cancer, infection or air collecting in the space around a lung (pneumothorax). They can also show chronic lung conditions, such as emphysema or cystic fibrosis, as well as complications related to these conditions. Heart-related lung problems.

Publié dans : Santé & Médecine
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Diagnosis of heart diseases from chest x ray

  1. 1. Diagnosis of heart diseases from a chest-Ray
  2. 2. Rule of 14 1. View :Chest X-RAY 2. P/A view 3. Centralised ? 4. Exposure 5. Cage, scapula and clavicle 6. Mediastinum 7. Situs 8. Cardiac silhouette 9. Vessels in the thorax 10. Diaphragm 11. Abdomen 12. Analysis 13. Provisional diagnosis 14. Suggestion for additional investigation if any
  3. 3. Cardiac Silhouette
  4. 4. Cardio- thoracic ratio • Widest transverse cardiac diameter/ widest inner thoracic diameter • Adult : less than 0.5 being normal • Neonates : less than 0.6 being normal • Limitation : • Expiratory Film • Addison's disease • Thin body built • Pregnancy • Children
  5. 5. Pulmonary plethora/congestion • Increased PBF • Dilated pulmonary arteries • Pulmonary arteries can be traced up to the rib cage • End appearances are more than 3 on right lung field • L –to –R shunts :ASD/VSD/PDA/TAPVC
  6. 6. Pulmonary arterial hypertension • Dilated MPA • Dilated RPA and LPA • Pruning of PA • Eisenmenger's complex/syndrome/IPAH
  7. 7. Pulmonary venous hypertension: Cardiogenic pulmonary odema • Stage -1:Pulmonary venous redistribution • Stage-2:Interstitial oedema • Stage-3:Alveolar oedema • Stage-4:Hemosiderosis
  8. 8. First stage: Cephalization: Viking Helmet sign or Antler horn sign: Mitral stenosis
  9. 9. Interstitial pulmonary oedema
  10. 10. Interstitial pulmonary oedema • Kerley's A lines (arrows) are linear opacities extending from the periphery to the hila; they are caused by distention of anastomotic channels between peripheral and central lymphatics • Kerley's B lines (white arrowheads) are short horizontal lines situated perpendicularly to the pleural surface at the lung base; they represent edema of the interlobular septa • Kerley's C lines (black arrowheads) are reticular opacities at the lung base, representing Kerley's B lines en face
  11. 11. Alveolar pulmonary oedema
  12. 12. Mitral stenosis • Double density (two superimposed convex densities) to the right of the spine • Splaying of the carina • Superior displacement of the left mainstem bronchus on the frontal radiograph and posteriorly on the lateral radiograph • Convexity of the left atrial appendage segment at the left heart border
  13. 13. Mitral stenosis :Morris and Macruz index
  14. 14. Second stage Fluid escapes from the pulmonary veins into the pulmonary interstitium Ill-defined pulmonary veins Peribronchial cuffing (end-on appearance of a thickened bronchus) Kerley B and Kerley A lines Kerley B lines are perpendicular, thickened interlobular septa in the subpleural lung Kerley A lines are 3 to 5 cm long, approximately 1 mm thick, and represent distended lymphatic vessels in the central part of the lung The PCWP :18 and 24 mm Hg in patients with interstitial pulmonary edema.
  15. 15. Third stage • Interstitial fluid pours into the alveolar space • Confluent, ill-defined airspace opacities on the radiograph • Classically, the airspace opacities are perihilar and symmetric in location, and they create a so-called bat-wing appearance • Severe in the lung bases than the apices • PCWP : 24 and 30 mm Hg in patients with airspace pulmonary edema
  16. 16. Fourth stage • Chronic pulmonary venous hypertension • Pulmonary arterial hypertension with dilatation of the main and hilar pulmonary artery segments • Parenchymal veins remain large at the lung apices and small at the lung bases • Red blood cells can extrude from the pulmonary arteries, deposit in the parenchyma, calcify, and cause parenchymal calcification.
  17. 17. Chest –Ray:3
  18. 18. Chest X-Ray :05 VSD with increased PBF
  19. 19. Chest X- Ray:06 ASD with PAH
  20. 20. Egg on string
  21. 21. Wide mediastinum :Ascending aorta dissection
  22. 22. Mediastinal shifting : hypoplastic Rt Lung
  23. 23. Water bottle sign and Oreo cookie sign • Thin arrow :Mediastinal fat • Thick arrow :Pericardial fat • Asterisk :Pericardial fluid
  24. 24. Wide mediastinum with acute tearing chest pain
  25. 25. the Fleischner sign • Enlargement pulmonary artery due to embolus occlusion
  26. 26. Hampton hump • Pulmonary hemorrhage or infarction secondary to pulmonary embolus can manifest radiographically as a wedge-shaped peripheral opacity, the Hampton hump
  27. 27. Thank you One goes by bus One goes by truck Everyone searches Best of their luck

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