Cardiovascular System

Zhengzhou university
1st affiliated hospital interventional department
Ma’nan( 马南 )
 Cardiovascular System
Method of Examination
 Physical examination
 Echocardiography,
 Radionuclide examinations
 X-ray examinations
 CT
– CT --- Normal CT
– SCT-- Spiral CT(hispeed CT)
– UCT --Ultrafast CT
 MRI
 Cardiovascular System
*Method of X-ray examinations
 Fluoroscopy or screening
 Teleradiography-2m—plain films
 Cardiac catheterization
 Angiocardiography
– Selective angiocardiography
 Kymography
X-ray plain films
Cardiac catheterization
Cardiac catheterization
Cardiac catheterization
 Angiocardiography
- Selective angiocardiography
 Cardiovascular System
X-Ray plain films

 Normal Cardio-vascular Shadow

– Postero-Anterior view (P-A view)
– Right anterior oblique view (RAO view or 1st oblique)
– Left anterior oblique view(LAO view or 2nd oblique vi
ew)
– Lateral view (LL , RL view)
Cardiovascular System
P-A view
Cardiovascular System
P-A view
 Cardiovascular System
P-A view

 Right border:
– The cardio-phrenic angle
– The inferior vena cava.
– The ascending aorta & the superior vena cava.
 adult - the ascending aorta dose not project outwards ov

er the shadow of the superior vena cava.

 olderly people with physiological unfolding of the aorta,

this situation is reversed and the ascending aorta with a l

ong convex curve forms the whole of the upper shadow.
 Cardiovascular System
P-A view

 Right border:
– The cardio-phrenic ang
le
– The inferior vena cava.
– The ascending aorta &
the superior vena cava.
the ascending aorta on P-A view
 Cardiovascular System
P-A view

 The left cardiac border .

– the left ventricle.
– the appendage
– pulmonary artery.
– the aortic knuckle
– the left cardio-phrenic
angle
Cardiovascular System
P-A view
 (RAO view or 1st oblique)
This view is obtained by rotating the patient to the left so that
his right shoulder is touching the screen. The angle of rotation is
usually 45 degrees.

 the anterior border

 aorta,
 right ventricle
 the left ventricle
 The posterior border
 the left auricle
 lie against the
esophagus
Cardiovascular System
(RAO view or 1st oblique)
 Cardiovascular System
(LAO view or 2nd oblique)

 This view is taken by

rotating the patient so
that the left shoulder is
touching the screen.
The angle of rotating is
usually 60-70 degrees.
 Cardiovascular System
(LAO view or 2nd oblique)

 the anterior contour

 (1) the ascending part of the aorta;
 (2) the appendage of right auricle;
 (3) the edge of the right ventricle.
 The posterior contour
 (1) a small part of left auricle;
 (2) the left ventricle.
 (3) The aortic arch, the descending aorta
– aortic window. the aortic triangle.
 Cardiovascular System
(LAO view or 2nd oblique)

 the anterior contour

– (1) the ascending part of
the aorta;
– (2) the appendage of
right auricle;
– (3) the edge of the right
ventricle
 Cardiovascular System
(LAO view or 2nd oblique)

 The posterior contour

– (1) a small part of left
auricle;
– (2) the left ventricle.
– (3) The aortic arch, the
descending aorta
 aortic window.
 the aortic triangle.
Cardiovascular System
(LAO view or 2nd oblique)
 Cardiovascular System
(LL view)

 In the lateral view the heart shadow is seen on the anterior

half of the diaphagm. The heart shadow lie adjacent to the
lower third of the sternum and xiphisternum.
 Cardiovascular System
(LL view)

 The anterior border

– the right ventricle
– the infundibulum.
– pulmonary arteries
– the ascending aorta
 Cardiovascular System
(LL view)

 The posterior border

– the left atrium above
– the left ventricle below
– The descending aorta
may be seen in the
elderly .
– the inferior vena cava.
Cardiovascular System
(LL view)
Physiological factors influencing the shape and
size of the heart

 (1) Body built:

 (2) Age:
 (3) Respiration:
 (4) Posture:
 (5)Other
Physiological factors influencing the shape and
size of the heart - Body built
Physiological factors influencing the shape and
size of the heart -Age:
Physiological factors influencing the shape and
size of the heart - Respiration
1st lesson over
 Basic X-ray Features in Diseases of Cardio-
vascular System

 1)Enlargement of heart
– (1) Left ventricular enlargement:
– (2) Right ventricle enlargement:
– (3) Left auricular enlargement:
– (4) Right auricular enlargement:
– (5) General enlargement of heart:
 2).change of aorta
 3)Abnormal pulsation in cardio-vascular diseaes:
 4)Pathological change in the pulmonary circulation:
– (1) Plethora: (2) Oligemia: (3) Pulmonary arterial hypertention:
– (4) Pulmonary venous hypertention: (5) Thrombo-emboic disease:
 The cardiothoracic ratio (CTR)

 Overall heart size is most

easily assessed on plain
chest radiographs. The
cardiothoracic ratio (CTR)
is a widely used but crude
method of measurement; in
normal people the
transverse diameter of the
heart is usually less than
half the internal diameter
of the chest
 Enlargement of heart
*(1) Left ventricular enlargement:
 In the P-A view
– the left side of the heart becomes more globular
, the apex of the heart extends downwards, post
eriorly and to the left.
– It can been seen under the shadow of the diaphr
agm through the gas bubble of the fundus of sto
mach.
– The point of opposite pulsation is pushed upwar
ds.
 Enlargement of heart
(1) Left ventricular enlargement:
 Enlargement of heart
*(1) Left ventricular enlargement
 In the LAO position
– it becomes increasingly difficult to clear the left
border from the spine. In some cases it is
possible to identify the interventricular groove
in the LAO position. This indentation is
displaced downwards and forwards in
enlargement of the left ventricle.
– Left ventricle enlargement is best assessed in P-
A, LAO and lateral views.
 Enlargement of heart
(1) Left ventricular enlargement:
 Enlargement of heart
*(2) Right ventricular enlargement:

 The common causes are mitral stenosis, congenital

failure, chronic pulmonary diseases
 The right ventricle enlarges chiefly to the left and
anteriorly.
 In the P-A view , the whole of the left border is
formed by the right ventricle.
 the point of opposite pulsation is pushed down-
wards.
 Enlargement of heart
*(2) Right ventricular enlargement:

 In the LAO view,

– the retrosternal space become smaller
– the interventricular groove and the left ventricle backward and
upward displacement.
 In the RAO view,
– a large right ventricle extends very high up the retrosternal space
– the infundibulum region is prominent.
– the heart rotate to the left, so as to make the aortic knuckle less
prominent.
 Enlargement of heart
(2) Right ventricular enlargement
 Enlargement of heart
**(3) Left atrium enlargement:
 The common cause of left auricular enlargement is mitral disease.
 The enlargement is displace to the right and posterior.
 the left main bronchus moves upwards.
 the esophagus displaces backwards and to the right.
 the left auricular appendage is enlarged and forms part of the left
contour.
Enlargement of heart
(3) Left atrium enlargement
Enlargement of heart
(3) Left atrium enlargement:
 Right atrium enlargement

 The commen cause of right auricular enlargement

are right heart failure, tricuspid disease and ASD.
 Enlargement of the right auricle is predominantly t
o the right and anteriorly.
 In the P-A view there is enlargement and bulging
of the right heart border is bulging and the angle f
ormed with the aorta is getting smaller, may be as
small as a right angle.
Right atrium enlargement
Right atrium enlargement
General enlargement of heart:
 This occurs with combined valvular lesions, advanc
ed stages of failure, myocardial weakness, endocrine
disturbances (myxedema) and severe or chronic ane
mic. Certain congenital heart diseases.
 the shadow is increased to the left and right,
 the oblique views show narrowing of both the retrost
ernal and retrocardiac spaces .
 the trachea bifurcation is splayed
 Lateral views are especially helpful in general enlarg
ement of the heart.
General enlargement of heart:
General enlargement of heart
2nd lesson over
 change of aorta
 The aorta is relatively fixed at two points, the heart an
d the diaphragm.
 If its elasticity is diminished or if the blood flow or pressure thr
ough it is increased, it must alter its shape , lenth and position b
etween these two points.
 It can be caused :
– (1)by an increase in the minute volume flow of blood such
as occurs in aortic incompetence ;
– (2)by hypertention
– (3)by degenerative or inflammatory changes causing fibrosi
s and loss of elasticity
 change of aorta
 Elongation and widening of
the aorta are characterised i
n the P-A view by a convex
projection of the ascending
aorta on the right side and a
considerable increase in the
distance between the notch
separating aorta from right a
uricle and the point where t
he aorta comes into the med
iastinum. The notch is lowe
r than normal, so that the rig
ht auricular shadow appears
small.
change in the pulmonary circulation:
(1) Plethora:
change in the pulmonary circulation:
(2) Oligemia
change in the pulmonary circulation:
(2) Oligemia
 change in the pulmonary circulation:
(3) Pulmonary arterial hypertention

 Pathological change in the pulmonary circulation:

– (2) Oligemia: :
– (4) Pulmonary venous hypertention: (5) Thrombo-emboic disease:
change in the pulmonary circulation:
(3) Pulmonary arterial hypertention
change in the pulmonary circulation:
(4) Pulmonary venous hypertention: