Prof. Dr. H.M. Arief Gella, Sp.Rad(K)Prof. Dr. H.M. Arief Gella, Sp.Rad(K)

Dr. Andi Darwis, Sp.RadDr. Andi Darwis, Sp.Rad

Cardiac Anatomy Cardiac Anatomy

The methods in assessment of The methods in assessment of

cardiac enlargement is by measuring cardiac enlargement is by measuring

the CTR (cardiothoracic ratio)the CTR (cardiothoracic ratio)

CTR should not exceed 50%CTR should not exceed 50%

CTR increased in the elderlyCTR increased in the elderly

CTR may be increased in the neonateCTR may be increased in the neonate

Cardiac Size Cardiac Size

Cardiac Size Cardiac Size

Here is a heart that is larger than 50% of the cardiothoracic ratio, but it is still a normal heart.This is because there is an extracardiac cause for the apparent cardiomegaly.

On the lateral film, the arrows point to the inward displacement of the lower sternum ina pectus excavatum deformity.

Here is an example of a heart that is less than 50% of the CTR, but the heart is abnormal. This is recognizable because there is

an abnormality of the heart contour (yellow arrows).

Right ventricular enlargement

Left ventricular enlargement

Five States of The Pulmonary VasculatureFive States of The Pulmonary Vasculature

NormalNormal Pulmonary venous hypertensionPulmonary venous hypertension Pulmonary arterial hypertensionPulmonary arterial hypertension Increased flowIncreased flow Decreased flowDecreased flow

What We’re Going to EvaluateWhat We’re Going to Evaluate

1.1. Right descending pulmonary Right descending pulmonary

arteryartery

2.2. Distribution of flow in the lungDistribution of flow in the lung Upper versus lower lobesUpper versus lower lobes

Central versus peripheralCentral versus peripheral

The Pulmonary VasculatureThe Pulmonary Vasculature

NormalNormal Pulmonary venous hypertensionPulmonary venous hypertension Pulmonary arterial hypertensionPulmonary arterial hypertension Increased flowIncreased flow Decreased flow – mostly Decreased flow – mostly

unrecognizable even when it is unrecognizable even when it is presentpresent

ReviewReview

Tetralogy of Fallot: Classic FindingsTetralogy of Fallot: Classic FindingsA. Coeur en sabot with characteristic elevation of the apex is seen [black arrow]. The

cardiac waist is narrow [long white arrow] because of the absence of poststenotic

pulmonary artery dilatation. The pulmonary vasculature is decreased, and the aortic

knob is prominent [short white arrow].

B. Lateral view demonstrates the prominent right ventricle [arrow]

Cyanotic Newborn

ASDASD

VSDVSD

PDAPDA

Severe PAH 2Severe PAH 2°° ASD ASD

Mitral StenosisMitral Stenosis

Combined MS & MICombined MS & MI

Aortic StenosisAortic Stenosis

Aortic InsufficiencyAortic Insufficiency

Combined AS & AICombined AS & AI

Hypertensive Heart Disease (HHDHypertensive Heart Disease (HHD

Cor Pulmonale and Pulmonary HypertensionCor Pulmonale and Pulmonary HypertensionThe main pulmonary artery segment [arrowhead] is dilated, and the peripheral vessels [arrows] are narrowed in a patient with longstanding emphysema. Enlargement of the right heart is seen most

clearly on lateral view.

Early Congestive Heart FailureEarly Congestive Heart Failure

Acute intraalveolar pulmonary edema in patient with left heart failure. Acute intraalveolar pulmonary edema in patient with left heart failure. Note the central distribution of edema fluid ‘batwing appearance’

in the upper and lower zone of the lung.

BallooningBallooning

C

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StentingStenting