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Chest X – Ray : Heart Failure

Chest X – Ray : Heart Failure. Dr.Juan A.Venter Dept.Imaging Sciences Universitas Hospital. Causes:PVH /Pulmonary Oedema. Left Ventricular Failiure Left Ventricular Outflow Obstruction Mitral Valve Disease Left Atrial Myxoma Fibrosing Mediastinitis

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Chest X – Ray : Heart Failure

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  1. Chest X – Ray : Heart Failure Dr.JuanA.Venter Dept.Imaging Sciences Universitas Hospital

  2. Causes:PVH/Pulmonary Oedema • Left Ventricular Failiure • Left Ventricular Outflow Obstruction • Mitral Valve Disease • Left Atrial Myxoma • FibrosingMediastinitis • Pulmonary Venous Occlusive Disease

  3. Non Cardiogenic Pulmonary Oedema – Normal Cardiothoracic Index • Aspiration ,Near Drowning • ARDS • HepatorenalFailiure • Post thoracocenthesis – Rapid Lung Expansion • Drugs : Aspirin,Nutrofurantoin,Opiates,Cytokines PS:Early post MI phase – acute decrease in miocardial compliance

  4. Right Atrial Enlargement PA CXR: • Prominent round superior border with SVC • > 5,5 cm from midline to most lateral RA margin • > 2,5 cm from right vertebral margin

  5. Right Ventricular enlargement PA CXR: • Upturned cadiac apex Lateral CXR: • > 1/3 contact distance from cadiophrenic sulcus to sternal angle

  6. Left Atrial Enlargement PA CXR: • Retrocardiac double density • >75 % splaying of carina with horizontal orientation of left mainstem bronchus • Enlarged left convex left atrial appendage • > 7 cm from LMB to right LA border. Lateral CXR: • Posterior displacement of Ba filled oesophagus

  7. Left Ventricle Enlargement PA CXR: • Downturned cardiac apex with leftward displacement • Left diaphragmatic inversion Lateral CXR: • Posterior cardiac margin > 1,8 cm posterior to IVC meassured 2 cm above intersection of right hemidiaphragm with IVC.(Hofman-Riglerrule)

  8. Cardiac vs Non Cardiac Oedema

  9. Congestive Cardiac Failiure

  10. Stages of CCF Stage 1 PCWP 13-18 mmHg Redistribution Interstitial Oedema Stage 2 PCWP 18 – 25 mmHg Stage 3 PCWP > 25 mmHg Alveolar Oedema

  11. Redistribution/Cephalization

  12. Redistribution

  13. Interstitial Oedema

  14. Interstitial Oedema

  15. Interstitial Oedema

  16. Alveolar Oedema

  17. Alveolar Oedema

  18. Gravity dependent density differences

  19. Cardiothoracic Index

  20. Pleural Effusion

  21. Vascular Pedicle Width: < 60 mm, > 85mm , 5mm = 1l

  22. VPW – Serial CXR

  23. Azygos Vein Width :Erect > 10 mm , Supine > 15 mm , Serial X Rays > 3mm,Not depending on in - or expiration

  24. Right Ventricular Failiure

  25. References 1.www.radiology assistant.nl – accessed 27/02/2012 2.Primer of Diagnostic Imaging – Fourth Edition 3.Radiology Review Manual – 6 th Edition

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