CARDIAC X RAY

Cardiac X-Ray Interpretation

The presentation provides an in-depth guide on interpreting chest X-rays (CXR) for heart-related conditions. It covers both technical and clinical aspects of X-ray imaging in cardiology.

Key Sections:

1. Basics of CXR:
   • Technical Quality (RIPE Criteria):
     • Rotation: Ensure medial clavicles are equidistant from the spine.
     • Inspiration: Adequate effort shows six anterior or ten posterior ribs.
     • Projection: PA (preferred) vs. AP view impacts visibility and heart size.
     • Exposure: Vertebral bodies should barely be visible.
2. Structures Identified:
   • Anterior View: Includes heart chambers, pulmonary vasculature, and aorta.
   • Lateral View: Highlights the retrosternal space, IVC, and pulmonary veins.
3. Heart Size and Cardiac Situs:
   • Cardiothoracic Ratio: Normal is up to 50% in adults.
   • Situs: Identifying organ positions for congenital anomalies.
4. Chamber Enlargement:
   • Right Atrial Enlargement: Vertical height >50% of the right heart border.
   • Left Atrial Enlargement: Signs include double atrial shadow and carinal widening.
   • Ventricular Enlargement: Distinct patterns for left and right ventricle enlargement.
5. Pulmonary Vasculature:
   • Features like venous/arterial hypertension, vascularity changes, and plethoras/oligemia.
6. Cardiac Calcification:
   • Differentiating pericardial vs. myocardial calcifications and identifying prosthetic heart valves.
7. Congenital Heart Diseases:
   • ASD, VSD, PDA, TOF, TAPVC, TGA: Characteristic CXR findings like “Egg on a String” for TGA and “Snowman Sign” for TAPVC.
8. Other Pathologies:
   • Pericardial Effusion: “Water bottle” appearance and narrow vascular pedicle.
   • Valvular Diseases: CXR changes in mitral and aortic valve diseases.
9. Special Equipment:
   • Identifying pacemakers, ICDs, and prosthetic valves on X-ray.
10. Clinical Case Examples:
    • Real-world CXR images for conditions like pericardial effusion, situs inversus, and cyanotic heart diseases.