Diagnostic Radiology of cardiovascular 2009.ppt

1、Diagnostic Radiology ofCardiovascular System,Chen, Shaoqiong Acknowledgement : most of the slices are refer to the ppt provided by Dr. Biling Liang is gratefully acknowledged.,2/231,Diagnostic Radiology ofCardiovascular System,Imaging methods,normal appearances,abnormities,diseases,Cadiovascular Ana

2、tomy,heart,多层螺旋心脏大血管CTA （三维重建图）,多层螺旋心脏大血管CTA （三维重建图）,Methods,X-ray Fluoroscopy Plain radiography ? Angiocardiography cardiac apex extending to left and down the point of opposite pulsation move down left ventricle segment extended,rounded,expand to left the aorta is prominent Lat：retrocardiac space

3、become narrowed or disappeared, esophageal space disappeaered Common disease： high blood pressure aortic incompetence、stenosis mitral incompetence congenital heart disease：PDA,32/231,Left ventricular enlargement,If we draw a tangent line from the apex of the left ventricle to the aortic knob (red li

4、ne) and measure along a perpendicular to that tangent line (yellow line),The distance between the tangent and the main pulmonary artery (between two small green arrows) falls in a range between 0 mm (touching the tangent line) to as much as 15 mm away from the tangent line,0 mm,MainPulmonaryArtery,A

5、o,15 mm,MainPulmonaryArtery,Ao,LV,LV,Main pulmonary artery ranges from 0 mm15mm from tangent line,35/231,Right ventricular enlargement,X-ray appearance： MPA prominent Lat：contact between the front surface of heart and the sternum (anterior chest wall) 1/3 (narrow of the retrosternal space) Common di

6、sease： Mitral valve stenosis Chronic pulmonary heart disease Pulmonary stenosis Pulmonary hypertension Fallots tetralogy ASD , VSD,36/231,Right ventricular enlargement,37/231,Left atrium enlargement,X-ray ：enlarged LA bulges to back & right PA right border：double density of left atrial enlargement P

7、A left border：Indentation where the left atrium, when it enlarges, will appear on the left side of the heart Lat & RAO：middle of esophagus compressed and displaced posteriorly LAO：Elevation of left mainstem bronchus Common disease： mitral lesion left ventricular failure congenital heart diseases： PD

8、A VSD,38/231,Left atrium enlargement,39/231,Right atrium enlargement,X-ray appearance： PA：inferior segment of right border of heart extending to right , bulge, high bulge point LAO：the right atrial curvature at least half as long as the anterior border of heart，bulge Common disease： right heart fail

9、ure ASD tricuspid disease pulmonary vein ectopy drainage atrial myxoma,40/231,Right atrium enlargement,41/231,General cardiac enlargement,X-ray appearance： PA：The cardiac shadow is increased to both sides, the transverse diameter increased Lat and RAO ：narrowing of both retrosternal space and retroc

10、ardiac space, the oesophagus is displaced backward LAO：the trachea bifurcation is sprayed, the trachea is displaced backward Common disease： Pericardial effusion Myocarditis Total cardiac failure Total cardiac failure, hyperthyroidism,42/231,general cardiac enlargement - Pericardial effusion,the fiv

11、e important cardiac contours are:,The ascending aorta Indentation where double density of left atrial enlargement will appear Aortic knob Main pulmonary artery segment Indentation where the left atrium, when it enlarges, will appear on the left side of the heart The right atrium and left ventricle a

12、re less important because we evaluate ventricular enlargement by looking at the outflow tracts for each ventricle.,44/231,Basic X-ray features,Heart dislocation Heart enlargement Abnormal pulmonary blood flow Changes of aorta Pericardial abnormal,Five States of the Pulmonary Vasculature,Normal Pulmo

13、nary venous hypertension Pulmonary arterial hypertension Increased flow Decreased flow,What Were Going to Evaluate,Right Descending Pulmonary Artery Distribution of flow in the lungs Upper versus lower lobes Central versus peripheral,Venous Hypertension,RDPA usually 17 mm,Upper lobe vessels equal to

14、 or larger than size of lower lobe vessels = Cephalization,Rapid cutoff in size of peripheral vessels relative to size of central vessels,Central vessels appear too large for size of peripheral vessels which come from them = Pruning,Pulmonary Arterial Hypertension,31,Increased Flow,RDPA usually 17 m

15、m,All of blood vessels everywhere in lung are bigger than normal,Increased Flow,Normal,Increased Flow,Distribution of flow is maintained as in normal,Lower lobe vessels bigger than upper lobe,Gradual tapering from central to peripheral,PAH,Increased Flow,Unrecognizable most of the time,Small hila,Fe

16、wer than normal blood vessels,Decreased Flow,54/231,Basic X-ray features,Heart dislocation Heart enlargement Abnormal pulmonary blood flow Changes of aorta Pericardial abnormal,55/231,Changes of aortal shape and density,elongation, widening ,calcification PA： Aorta distortion: the ascending and desc

17、ending aorta displacement exceeding the heart boundary , intruding the lung field The demarcation between the ascending aorta and right atrium descend Aorta elongation: aortic knob is high , above the clavicula sometimes Lat： Ascending and descending aorta bend forward, backward respectively，,56/231

18、,Aorta distortion and elongation,57/231,Aorta calcification,58/231,Aorta calcification,59/231,Coronary artery calcification,60/231,Dissection of aorta,Symptom： Severe chest-back pain suddenly, with tearing sensation , radiating to the neck and abdomen Pathology：Hemorrhage in the media separate media from adventitia, and form pseudocoele inside the aortal wall,Medical emergency,Clue for diagnosis intimal tear point intimal flap pseudocoele,61/231,Dissection of aorta,Types DeBakey Type I Involv