Diseases
An Atlas of Cardiac X-rays
PART 3
The Cardiac Shadow
Radiology of cardiac chambers in health and disease
1. Pericardial Effusion
Fig. (33): Three prosthetic cardiac valves replaced the mitral (M),
aortic (A) and tricuspid (T) valves.
Breast Shadow:
Sometimes breast shadow may be superimposed partly on the
cardiac shadow and gives the impression of abnormal cardiac
configuration, (Fig. 34).
Fig. (34): (Left) Normal female breasts apparent on the sides of the chest
wall. (Right) Unusually elevated breasts in an elderly female (arrows)
superimposed on the cardiac shadow.
Abnormal Calcification
Calcification may occur in the pericardium, cardiac valves, the
cardiac wall itself, intra cardiac thrombi or tumours or the aorta.
Fig. (39): Calcification in the mitral valve (black arrow heads) and
the aortic valve (white arrow head)
Fig. (42): Calcified myocardial aneurysm seen in PA view (a) and lateral view (b)
D. Calcification Left Atrium, (Fig. 43).
Rarely the left atrial wall itself is calcified and very rarely
calcification may be seen in an atrial myxoma.
Fig. (43): Calcification in the left atrial wall in a case of rheumatic mitral valve
disease seen in the PA (a) and lateral (b) views
E. Calcification of the Aorta
Calcification may occur in an atherosclerotic plaque in any
part of the aorta.
2. The right atrium forms the lower two thirds of the right cardiac
border. The tricuspid valve, which is situated behind the lower
end of the sternum, connects it to the right ventricle.
b. The aortic arch curves to the left and posteriorly and forms
a prominence on the left cardiac border at the medial end of
the first left intercostals space.
X-ray. (49): Enlargement of the Right X-ray. (50): Isolated Enlargement of the
Atrium and Ventricle Right Atrium in case of Tricaspid Stenosis
Right Ventricular Enlargement:
1. There are no reliable signs for its diagnosis in the PA view, but
better seen in the lateral view. However, enlargement of the RV
displaces the apex outwards which may become separated form
the diaphragm, (Fig. 51).
Fig. (52):Right ventricular enlargement with right sided aortic arch; diagrammatic
and in the X-ray of a case of Fallot’s Tetrology
3. In the lateral view the anterior wall of the right ventricle lies
directly behind the lower third of the sternum. In the upper two-
thirds lung tissue separates the sternum from the cardiac
shadow and the retrosternal space is radiotranslucent. As the
right ventricle enlarges, it displaces the lung tissue and the
retrosternal space becomes filled with the right ventricle, (Fig.
53).
Fig. (55): Moderate (left) and aneurysmal (right) dilatation of the left atrium
4. The left atrium pushes the left main bronchus upwards which
becomes more horizontal than normal and causes widening of
the carina.
5. The left atrial size can be estimated by giving the patient barium
to swallow and X-ray is taken in the lateral or right anterior
oblique positions. The esophagus is displaced backwards by
the enlarged left atrium, (Fig. 56).
Fig. (56): Enlarged left atrium displacing the esophagus posteriorly. The right
ventricle is also enlarged causing obliterations of the retrosternal
space and causing anterior displacement of the sternum (precordial
bulge)
Left Ventricular Enlargement:
1. In cases of concentric LV hypertrophy due to pressure
overload the only sign may be accentuation of the convexity of
the lower half of the left cardiac border which becomes
chunky, (Fig. 57).
Fig. (62): Small (left) and large (right) left ventricular aneurysm
The Aorta: Fig. (63)