Documente Academic
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Documente Cultură
Dr. Yanto Budiman, Sp.Rad, M.Kes Bagian Radiologi RS/FK Atma Jaya Jakarta
2. Mediastinum
The heart and great vessels occupy the mid thorax, within the mediastinum The anatomic borders of the mediastinum : 1. Anteriorly : the sternum and its adjacent ribs 2. Posteriorly : the vertebral column and its ribs 3. Laterally : the medial aspects of the parietal pleuras 4. Superiorly : the plane of the 1st rib 5. Inferiorly : the diaphragm
- Aortic arch
- Diaphragm
and transversal
Childhood Adult
2. Respiration
Deep inspiration
Expiration
6. Cardiothoracic ratio
M = midline A = 1/3 C1 B = C1 D + E = 4 cm F = height of the aorta, 2 cm form the edge of the manubrium A + B X 100% CTR = C1 + C2
versa
Pulmonary arteries Pulmonary veins Aorta
Pulmonary artery/veins
Normally : Blood (RV) --> thru PA --> Right and Left Lungs
PA tributaries (small arteries) with bronchi to the alveoli capillaries PVs (capillary plexus) in alveoli septa --> to medial part of the lungs --> wider --> LA PVs of the lungs basis --> to the lower part of LA PVs of the other part of the lungs --> to the upper part of LA
Pulmonary artery
Hilum : consist of the pulmonary
Pulmonary artery
Hilum : consist of the pulmonary
nodes
Right hilum : in the middle of right
PATHOLOGY
ABNORMALITIES OF LUNG VASCULATURES Abnormalities of pulmonary vessels
Vascular widening
Vascular narrowing
Pathways irregularity
Vascular widening
Hilum enlargement > 16 mm, conform with trachea node enlargement - prominentmediastinal enlargement pulmonal artery widening(MPA)
Vascular narrowing
Vascular narrowing : pulmonary stenosis : decrease of blood volume in lungs, ---
hypertrophy, dilatation
CONGENITAL ANOMALY
Abnormality of the septum
2.CHD with decreased vasc Cyanosis (+) marking T4F (PS, VSD, TA, RVH)
T3F (FS, ASD, RVH) PA TA Ebstein Anomali
Cyanosis (-)
PS (Valvuler, Infusidubuler, Supravalvuler) HP Primer
Septum primum Ostium primum closed Septum secundum Foramen ovale closed
Chest X ray
Depends on :
The severity of the defect Complication
L to R shunt
R to L shunt
Chest X ray
Without pulmonary hypertension PA position
- Heart enlargement to left side - Apex is rounded & upward - Widening of the hila - Widening of pulmonary artery and its tributaries - Widening of pulmonary veins at supra and perihilar - Periphery pulmonary vascular are clear - Prominence of MPA - Aortic arch is small Increased pulmonary vascular marking
Chest X ray
Lat Position
No enlargement of LA & LV Enlargement of RV
sides Extremely wide of central hila and became smaller to periphery MPA is very prominent Small aorta Pulmonary veins are faint Periphery area is more radio lucent Barrel chest
Lateral position
LV Enlargement
LA is normal/enlarged
RV Enlargement sternum Hilar enlargement Infero-posterior part of the heart overlapping with vertebral column close to upper
Clinical manifestation
- Small VSD : N growth, development, symptoms
Localization of defect
Membranous septum Muscular septum Above the crista supra ventricular/ sub ulmonic
Chest X ray
Tiny defect (maladies de Roger )
No heart enlargement
Small defect
Heart enlargement to left side (LVH) Dilatation of LA Dilatation of RV Increased pulmonary vascular markings Apex towards diaphragm
Chest X ray :
LA dilatation LV hypertrophy PA PV LA are enlarged LV AO RV dilatation (large defect)
Small PDA :
Heart Pulmonary vascularities N
Moderate PDA :
Ascending aorta N/slightly enlarged aorta arch PA : prominent next to AO Pulmonary vascular markings : increased Hila : wide R LA : enlarged LV are enlarged RV
Chest X ray
Important RA RV PA are enlarged
Similar to ASD Heart enlargement (RA, RV) Widening of MPA Widening of hila Occasionally : a dilated PVC, a crescent, shaped, vertical shadow in the right lower lung
vascular
Chest X rays
Heart enlargement, oval shaped (RV, LV, LA)
Increased pulmonary vascularity A right aortic arch (50%)
with
A. Without cyanosis 1. Pulmonary stenosis Incidence 5% - 8% of all congenital heart defects Valvular stenosis Subvalvular stenosis (infundibulum) Supravalvular stenosis (mainstem of PA)
Chest X rays
Heart size is normal RV enlargement : hyperthrophy dilatation MPA is prominent Pulmonary vascularity is normal decreased Heart enlargement (CHF) Lung : more lucency (small lung vessels) Different vascularization between right and left lung on valvular stenosis Post stenotic dilatation
Chest X ray
RV : enlargement, extends heart to left Apex : upturned Concavity of heart waist/MPA Booth shaped/coeur en sabot Lungs vessels are smaller increased radiolucency Widening of the aortic arch Right sided aorta/aortic arch (25%)
2. Trilogy of Fallot Similar to Tetralogy of Fallot excluded VSD/overriding aorta Abnormalities are : Pulmonary stenosis RVH Leakage of atrial septum thru ASD/persisten foramen ovale Chest X ray Similar to PS imaging RVH Apex : uptoward Decreased pulmonary vascularity
3. Pulmonary atresia Is a part of RV hypoplasie RV : small PA : absent VSD : absent Combination between ASD & PDA Chest X ray Heart enlargement, oval shaped LA enlargement RA enlargement LV enlargement Concavity of heart waist
Involved valves valves weakness 2 chorda tendinae weakness valves are insuficient narrowing of the valve Valve narrowing LA dilatation (because of
Chest X ray
Changing of : - heart shaped & - pulmonary vascularity
PA
LA dilatation Double contour in right side Prominence of LAA, MPA Elevation of main stein left bronchus Small aorta Heart enlargement to left with upright apex Displaced esophagus to right side
Lateral
Without contrast
Holtzknecht space is clear
With contrast
Displaced esophagus posteriorly
2. Mitral insuficiency Incidence : - the most common valvular involvement in children with RHD - Males are more commonly affected than females
Etiology
: Rheumatic fever
Chest X rays
PA : - Enlargement of LA & LV - Pulmonary vascularity is usually within normal limits - Double contour - Auricle of LA prominent - Elevation of the left mainstem bronchus - Displacement esophagus to right Lat : - Displacement esophagus posteriorly - LV protruded posteriorly
3. Aorta insuficiency
Incidence : - More common in males than females - Rheumatic endocarditis - Aneurysma - Aortasclerotic
Chest X ray :
PA : - apex turned down
4. Aortic stenosis
Incidence : - 5% of all congenital heart defect - more common in males than females (4:1) Chest X ray :
PA
Lat
5. Tricuspid insuficiency
Incidence
Etiology
Chest X ray :
PA LAO RAO : - RA dilatation - pulmonary vascularity : decreased : auricle RA : more prominent : enlargement RA, protruded posteriorly, beneath LA most commonly congenital
6. Pulmonary stenosis
Etiology :
Aortic anomalies/abnormalities
Etiology : - inflammation process - degenerative process - traumatic factor - congenital Aortitis Aortasclerotic Aortaelongation Aortic aneurysm
Coarctatio aortae
Vascular ring