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Cardiac Radiography Jared D. Christensen, M.D.

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Page 1: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

Cardiac Radiography

Jared D. Christensen, M.D.

Page 2: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

Cardiacradiography

Jared D. Christensen, M.D.

Page 3: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

OverviewBasic Concepts

Technique

Normal anatomy

Cases

Page 4: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

Technique

Page 5: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

3 Standard Views

Posterior-Anterior (PA) Anterior-Posterior (AP) Lateral

Page 6: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

MagnificationR L

Page 7: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

PA AP

Page 8: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

Cardiac Anatomy

Page 9: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

2

4

5

78

9

61

3

Cardiac Anatomy1. R brachiocephalic v./ SVC2. Ascending Aorta3. R atrium4. IVC5. L brachiocephalic v./ L

subclavian a.6. Aortic arch7. Main pulmonary a.8. L atrial appendage9. L ventricle

Page 10: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

23-year old male with acute chest pain

Page 11: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian
Page 12: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

Q Where is the abnormality?

A

B

C

D. It’s normal

Page 13: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

Q Where is the abnormality?

A

B

C

D. It’s normal

Page 14: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

Q Where is the abnormality?

A

B

C

D. It’s normal

�

Page 15: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

Q

A. Mediastinal massB. Aortic dissectionC. Pulmonary embolismD. Lymphadenopathy

What is the most likely diagnosis?

Page 16: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian
Page 17: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian
Page 18: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

Aortic Dissection - Marfan Syndrome

Page 19: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

Chambers

Page 20: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

Cardiac Chambers1. L Atrium

2. R Atrium

3. L Ventricle

4. R Ventricle1

23

4

Page 21: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

Heart SizeCardiac Index:

A

B

A

B

Page 22: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

Heart SizeCardiac Index:

A

B

A

B

Normal: ! 50%

Page 23: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

Heart Size

D i l a t i o n

Hypertrophy

Volume

Pressure

Page 24: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

Left Atrium

• Big left atrial appendage

• Retrocardiac double density

• Elevated left mainstem bronchus

Page 25: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

Left Atrium

• Big left atrial appendage

• Retrocardiac double density

• Elevated left mainstem bronchus

Page 26: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

Left Atrium

• Big left atrial appendage

• Retrocardiac double density

• Elevated left mainstem bronchus

Page 27: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

Left Atrium

• Big left atrial appendage

• Retrocardiac double density

• Elevated left mainstem bronchus

Page 28: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

Left Atrium

• Big left atrial appendage

• Retrocardiac double density

• Elevated left mainstem bronchus

Page 29: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

Left Ventricle

• Enlarged left heart border

• Apex moves down and leftward

Page 30: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

Left Ventricle

• Enlarged left heart border

• Apex moves down and leftward

Page 31: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

Left Ventricle

• Enlarged left heart border

• Apex moves down and leftward

Page 32: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

Right Atrium

• Divide hemithorax into thirds

• Right heart border is > ⅓

Page 33: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

Right Atrium

• Divide hemithorax into thirds

• Right heart border is > ⅓

Page 34: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

Right Atrium

• Divide hemithorax into thirds

• Right heart border is > ⅓

Page 35: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

Right Ventricle

• Elevated cardiac apex

• “Boot-shaped” heart

Page 36: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

Right Ventricle

• Elevated cardiac apex

• “Boot-shaped” heart

Page 37: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

Right Ventricle

• Elevated cardiac apex

• “Boot-shaped” heart

Page 38: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

Valves

Page 39: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

ValvesTricuspid

Mitral

Aortic

PulmonicMT

PA

Page 40: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

Valves

MT

PA

Page 41: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

Valves

MT

PA

Page 42: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

Valves

MT

PA

PA

T M

Page 43: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

Q Which valve is calcified?

Page 44: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

Q

A. AorticB. PulmonicC. Mitral D. Tricuspid

Which valve is calcified?

Page 45: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian
Page 46: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

Heart Size

D i l a t i o n

Hypertrophy

Volume

Pressure

Page 47: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

Valve Disease

Normal directional flow

Reversed directional flow

Stenosis

Insu!ciency

Valve doesn’t fully open

Valve doesn’t fully close

Page 48: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

Mitral Insu"ciency

• Left atrium dilates

• Left ventricle dilates (over time)

• Normal pulmonary vasculature

Page 49: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian
Page 50: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

Mitral Insu!ciency - Acute MI

Page 51: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

Mitral Stenosis

• Left atrial hypertrophy/dilation

• Dilated pulmonary veins, then arteries

• Dilated right ventricle

Page 52: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian
Page 53: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

Mitral Stenosis

Page 54: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

Aortic Insu"ciency

• Left ventricle dilates

• Aorta may eventually dilate due to increased LV volumes

Page 55: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian
Page 56: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

Aortic Insu!ciency

Page 57: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

Aortic Stenosis

• Left ventricle hypertrophy/dilation

• Post-stenotic dilation of ascending aorta

• Pulmonary vessels are normal

Page 58: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian
Page 59: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

Aortic Stenosis (& Insu!ciency)

Page 60: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

Pulmonic Stenosis

• Right ventricle hypertrophy/dilation

• Post-stenotic dilation of pulmonary artery

Page 61: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

Pulmonic Stenosis

Page 62: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

Pericardium

Page 63: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

PericardiumAnatomy:

‣ Visceral

‣ Space

‣ Parietal

Page 64: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

6 weeks ago

Page 65: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian
Page 66: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian
Page 67: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

Pericardial E"usion

Page 68: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

Vasculature

Page 69: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

VasculatureThoracic Aorta

Pulmonary Arteries

Pulmonary Veins

Page 70: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian
Page 71: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

2 days later

Page 72: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

4 days later

Page 73: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

4 days later

Pulmonary Edema

Page 74: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

Interstitial

Kerley B Lines

Page 75: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian
Page 76: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

Interstitial Alveolar

Page 77: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

Cases

Page 78: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian
Page 79: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

1

Page 80: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

Q What surgery has this patient had?

Page 81: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

Q What surgery has this patient had?

A. AVRB. Cardiac TxpC. CABGD. Lung Txp

Page 82: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

Q What surgery has this patient had?

A. AVRB. Cardiac TxpC. CABGD. Lung Txp

Page 83: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

Q What surgery has this patient had?

A. AVRB. Cardiac TxpC. CABGD. Lung Txp

�

Page 84: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

Q Which tube/line is malpositioned?

D

C

A

B

Page 85: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

Q Which tube/line is malpositioned?

D

C

A

B

Page 86: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

Q Which tube/line is malpositioned?

D

C

A

B�

Page 87: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian
Page 88: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

R Mainstem Intubation

Page 89: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

R Mainstem Intubation

Page 90: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

52-year-old male with chest pain and dyspnea.

Page 91: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

52-year-old male with chest pain and dyspnea.

2

Page 92: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian
Page 93: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian
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Q Which chamber is abnormal?

Page 95: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

Q Which chamber is abnormal?

A. Left atriumB. Left ventricleC. Right atriumD. Right ventricle

Page 96: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

Q Which chamber is abnormal?

Page 97: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

Q Which chamber is abnormal?

A. Left atriumB. Left ventricleC. Right atriumD. Right ventricle

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Page 98: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian
Page 99: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian
Page 100: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

Left Ventricle Aneurysm

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54-year old male with chest pain and dyspnea

3

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Q Which is the next most appropriate step in management?

Page 106: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

Q

A. BiopsyB. PET-CTC. CTA D. Surgical resection

Which is the next most appropriate step in management?

Page 107: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

Q

A. BiopsyB. PET-CTC. CTA D. Surgical resection

Which is the next most appropriate step in management?

Page 108: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

Q

A. BiopsyB. PET-CTC. CTA D. Surgical resection

Which is the next most appropriate step in management?

�

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Page 110: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

Aortic Arch Pseudoaneurysm

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Page 112: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian
Page 113: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian
Page 114: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian
Page 115: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

Conclusions

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ConclusionsLearn what is normal

Be systematic in your interpretation

‣ Contours, Chambers, Valves

Physiology predicts pathology

Page 117: Cardiac Radiography - Duke University · 2 4 5 7 8 9 1 6 3 Cardiac Anatomy 1. R brachiocephalic v./ SVC 2. Ascending Aorta 3. R atrium 4. IVC 5. L brachiocephalic v./ L subclavian

Jared D. Christensen, M.D.

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Jared D. Christensen, M.D.

Cardiacradiography


A Brachiocephalic Vascular Syndrome Associated with Cervical Rib

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