Chest X – Ray : Heart Failure

Dr.Juan A.VenterDept.Imaging Sciences

Universitas Hospital

Causes:PVH/Pulmonary Oedema

• Left Ventricular Failiure • Left Ventricular Outflow Obstruction• Mitral Valve Disease• Left Atrial Myxoma• Fibrosing Mediastinitis• Pulmonary Venous Occlusive Disease

Non Cardiogenic Pulmonary Oedema – Normal Cardiothoracic Index

• Aspiration ,Near Drowning• ARDS• Hepatorenal Failiure• Post thoracocenthesis – Rapid Lung Expansion• Drugs : Aspirin,Nutrofurantoin,Opiates,Cytokines

PS:Early post MI phase – acute decrease in miocardial compliance

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

Right Ventricular enlargement

PA CXR:• Upturned cadiac apex

Lateral CXR:• > 1/3 contact distance from cadiophrenic

sulcus to sternal angle

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

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-Rigler rule)

Cardiac vs Non Cardiac OedemaSigns Cardiac Renal /Fluid

OverloadARDS

CARDIOMEGALY (uremic pericarditis)

VASCULAR REDISTRIBUTION Balanced

WIDENED VASCULAR PEDICLE

KERLEY LINES

PERIBRONCHIAL CUFFING

AIRSPACE OPACIFICATION Basal Central Diffuse

PLEURAL EFFUSIONS Very Common

Common

Congestive Cardiac Failiure

Stage 1 PCWP 13-18 mmHg

Stage 2PCWP 18 – 25 mmHg

Stage 3PCWP > 25 mmHg

Redistribution

Interstitial Oedema

Alveolar Oedema

Stages of CCF

Redistribution/Cephalization

Redistribution

Interstitial Oedema

Interstitial Oedema

Interstitial Oedema

Alveolar Oedema

Alveolar Oedema

Gravity dependent density differences

Cardiothoracic Index

Pleural Effusion

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

VPW – Serial CXR

Azygos Vein Width :Erect > 10 mm , Supine > 15 mm , Serial X Rays >

3mm,Not depending on in - or expiration

Right Ventricular Failiure

References

1.www.radiology assistant.nl – accessed 27/02/20122.Primer of Diagnostic Imaging – Fourth Edition3.Radiology Review Manual – 6 th Edition