Lecture Cardiac Cases

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CXR Enlarged Pulmonary Artery
Ashley Davidoff
TheCommonVein.net

Isolated Enlarged Pulmonary Artery Enlargement 

Enlarged Pulmonary Artery on CXR

 

  • Causes
    • Idiopathic Dilatation of the Pulmonary Artery
    • Pulmonary Stenosis  Absent Pulmonary Valve
    • Pulmonary Hypertension
        • resting mean PA pressure of >25mmHg 
          • Normal mean <12mmHg
          • Normal systolic <20mmHg
      • Increased Pressure
        • Left Heart Failure
        • Lung Disease Cor Pulmonale 
        • Recurrent PE’s
        • Other
            • Drugs
            • fenfluramine
            • dexfenfluramine
            • toxic rapeseed
            • oilamphetamines
            • L-tryptophan
          • HIV-associated pulmonary arterial hypertension
          • Hepatopulmonary Syndrome
          • Connective tissue disease (vasculitis)
          • Idiopathic

2

 

CXR Enlarged Left Ventricle and Pulmonary Artery with increased flow
Ashley Davidoff
TheCommonVein.net

Left ventricular Enlargement Left Atrial Enlargement Enlarged Pulmonary Artery and Increased

CHF

VSD Large PDA

CXR and Cardiomegaly

3

CXR shows a triangular shaped heart with upturned apex indicating right ventricular enlargement . In addition there is left atrial enlargement characeterised by elevated left mainstem bronchus, double density and straightening of the left heart border. These findings are consistent with mitral stenosis
and likely rheumatic in origin
Ashley Davidoff TheCommonVein.net 08012
CXR shows a triangular shaped heart with upturned apex indicating right ventricular enlargement . In addition there is left atrial enlargement characeterised by elevated left mainstem bronchus, double density and straightening of the left heart border. These findings are consistent with mitral stenosis
and likely rheumatic in origin
Ashley Davidoff TheCommonVein.net 08013b

 

  • DX
    • Mitral Stenosis

Mitral Stenosis

 

4

CXR showing “snowman” sign or figure of eight appearance resulting from supracardiac total anomalous drainage of the pulmonary veins to the vertical vein with subsequent drainage into the innominate vein and right sided SVC and then into the right atrium
Nutrient Consumption among Tribal and Non Tribal Children
January 2017
DOI: 10.21088/per.2321.1644.5217.14
Shivamurthy Y.L.Rashmi H.K.Arunkumar NKallenahalli Jagadish KumarKallenahalli Jagadish Kumar
  • Enlargement of the vertical vein
  • Innominate vein
  • SVC

 

5

86774
CXR shows an enlarged main pulmonary artery and branch pulmonary arteries with peripheral pruning indicating pulmonary hypertension
Ashley Davidoff TheCommonvein.net

 

Enlarged pulmonary artery
Pruning

DX Pulmonary Hypertension

6

CXR showing the egg on its side appearance of the heart with narrow mediastinum reflecting D transposition of the great arteries (DTGA) with increased blood flow

Enlarged left ventricle
Narrow Mediastinum
Increase Pulmonary Blood Flow

DTGA 

7

CXR shows a boot shaped heart indicating a small main pulmonary and an enlarged right ventricle characteristic of Tetralogy of Fallot

Enlarged Right ventricle  Boot Shaped heart
Small Pulmonary artery
Question Right Aortic Arch

Tetralogy of Fallot

8

CXR shows a very prominent soft tissue structure in the AP window. In this case the diagnosis is corrected transposition. Differential diagnosis includes partial absence of the pericardium
  • Abnormal Soft tissue in the region of the AP window
      • Anatomical differential
        • aorta
        • MPA
        • lymph nodes
        • left atrial appendage

LTGA

Left atrial appendage abnormalities See Left Atrium

9

CXR shows a very prominent soft tissue structure in the AP window. In this case the diagnosis was partial absence of the pericardium Differential diagnosis includes corrected transposition and juxtaposition of the left atrial appendage

 

Congenital Absence of the Pericardium

 

10

CXR shows a box shaped heart characteristic of Ebstein’s anomaly
Ashley Davidoff TheCommonVein.net 01486
  • Enlarged Right Atrium
  • Box Shaped heart

Ebsteins Anomaly

12

CXR showing dextrocardia and situs solitus indicating a higher incidence of congenital heart disorders

Dextrocardia

  • ? Situs

 

13

WATERBOTTLE HEART
X-ray shows the typical appearance of a “water bottle heart” characteristic of a pericardial of a large pericardial effusion.
Ashley Davidoff MD TheCommonvein.net

Pericardium

Waterbottle Heart

Pericardial Effusion
Tamponade

 

Size 1 = normal heart 2 = LV enlargemnet 3 = RV enlargement 4 large mediastinum = snowman TAPVR supracardiac dilated left vertical vein and SVC 5 = large PA = pulmonary hypertension Eisenmenger 6 small mediastinum = DTGA
7 TA Pulmonary atresia pulmonary bay PAtresia TEt 8 L TGA Coronal LTGA is 07197 9 total absent pericardium 10 Tetralogy 11 dextrocardia 12 waterbottle pericardial effusion
Coronal LTGA is 07197

What Next?  Cardiac Cases