cardiology rad.ppt

8/10/2019 cardiology rad.ppt

http://slidepdf.com/reader/full/cardiology-radppt 1/79

RADIOLOGY OF THE

HEART AND GREATVESSELS

William H. Adams DVM

Associate Professor, Radiology

College of Veterinary Medicine

University of Tennessee



NORMAL ANATOMY -

THE HEART



Cardiac Silhouette

Delineates external margins of heart/ pericardium

Unable to define internal features of cardiac chambers

Unable to determine wall thickness or chamber size

Unable to delineate valvular morphology



Normal Variants

Feline cardiac silhouette consistent

Canine cardiac silhouette varies widely

breed

size

body type



Normal Feline

Lateral Projection

2 to 2.5 ICS wide

2/3 DV thoracic

diameter

Trachea deviates from

spine



Normal Feline

VD/DV Projection

Apex slightly to left ofmidline

Broad convexity in areof right atrium and leftventricle

Flat left auricle area



Normal Canine

Deep-chested conformation Doberman, Collie

Lateral projection:

Upright orientation -perpendicular to spine

2/3 DV diameter

2.5 intercostal spaces

Trachea deviates from spine



Normal Canine

Deep-chested

Doberman, Collie

VD/DV projection circular to ovoid heart

apex median to slightly left of

midline



Normal Canine

Intermediate German Shepherd Dog

Labrador Retriever

Lateral projection

3 intercostal spaces base angled craniodorsall

2/3 DV diameter

tracheal deviates from spi



Normal Canine

Intermediate conformation German Shepherd Dog Labrado

Retriever

VD/DV projection

more elongated

apex to left



Normal Canine

Shallow-chested Boston terrier, Bulldog

Lateral projection heart shorter, more round

2/3 or greater DV diameter 3 to 3.5 intercostal spaces

tracheal deviation - less

greater "sternal contact"

(unreliable sign)



Normal Canine

Shallow Conformation Boston terrier, Bulldog

VD/DV projection

short distance from thoraci

inlet to cupola of diaphragm heart round to elongated

apex shift to left



EVALUATION

OF THE

CARDIAC

SILHOUETTE



VD / DV

Clockface Analogy 11:00 - 1:00 =Aortic Arch

1:00 - 2:00 =Main PA

2:30 - 3:00 =Left Auricle

2:00 - 5:00 =Left Ventricle 5:00 - 9:00 =Right Ventricle

9:00 - 11:00 =Right Atrium

Tracheal Bifurcation = Left

Atrium

AA PAS

LAu

RV

LV

RA

LA



Lateral

Cranial border Dorsal 1/3 (cranial waist)

right auricle

ascending aortic arch

main pulmonary artery

Ventral 2/3wall of RV

pulmonary outflow tract



Lateral

Caudal border

Caudal waist

Left atrium

Left ventricle



Angiocardiography

Chamber size

Wall thickness

Valvularconformation

Transit time



Angiocardiography

Non-selective

Contrast injection in peripheral vein

Selective

Catheter placement in area of interest Fluoroscopy

cardiac chamber

vessel



Non-selective Angiogram

Indications

Valvular stenoses

Right to left shunts

Assess chamber size and wallthickness

Pericardial effusion



Cardiomegaly

Most consistent indicator of heart disease

Wide range of normal

Mensuration techniques of questionable value

Diagnosis more secure as severity of changes

increases



Left Atrial Enlargement (LAE)

Dorsal displacemeof main stem bron

Convexity of caud

waist

Increased size ofcaudodorsal borde



Left Atrial Enlargement (LAE)

Double opacity sign

Separation of main stem

bronchi

"Bow-legged cowboy"

Left auricular

enlargement (LAuE)



Left Ventricular Enlargement (LVE)

Dorsal displacement of thtrachea

Increase in proportion ofDV diameter of thorax

Straightening of caudalborder



Left Ventricular Enlargement (LVE)

Elongation of cardiac

silhouette

Deviation of cardiac apex

to left

Increased prominence in

2:00 - 5:00 region



Right Atrial Enlargement (RAE)

Lateral view

Dorsal Bowing of trachecranial to carina (J-sha

Convexity of cranial wa



Right Atrial Enlargement (RAE)

VD/DV view Increased

prominence in 9:00 -

11:00 region



Right Ventricular Enlargement (RVE)

Lateral view Increased width o

the cardiacsilhouette

Increasedconvexity ofcranial margin

Tracheal changesas in RAE





VD/DV View

Increased

prominence in 5:00

- 9:00 region

"Reverse D" shape

Generalized Cardiomegaly



Generalized Cardiomegaly

Combination of Roentgen signs involving bothleft and right cardiac chambers



Microcardia

Cardiac silhouette < 2 1/2 intercostal spaces

wide

Supporting Roentgen signs Pulmonary hypoperfusion

Consistently small caudal vena cava

Ddx: dehydration, shock, hypoadrenocorticism

Mi di



Microcardia



NORMAL ANATOMY -

The Great Vessels



Aorta

Generalized enlargement

Segmental enlargements

Aortic arch - 11:00 - 1:00 (VD, DV) Proximal descending aorta (ductus

arteriosus)



Main Pulmonary Artery Segment

(PAS)1:00 - 2:00 region (VD, DV)

Associations

Pulmonary hypertension

Pulmonary outflow tract stenosis



DISEASES OF THE HEART

AND GREAT VESSELS



CONGESTIVE HEART FAILURE -

RADIOGRAPHIC DIAGNOSIS

Left Heart Fail re



Left Heart Failure

Definition: Inability of the heart to adequatelyhandle volume of blood returning from pulmonarycirculation

Pulmonary Venous Congestion

veins > arteries

Pulmonary Edemacaudodorsal / perihylar pulmonary infiltrate

interstitial >>> alveolar

Left-sided or Generalized Cardiomegaly



Left Heart Failure

Veins > arteries Caudodorsal

Pulmonary infiltratenonstructured

interstitialperibronchial

alveolar



Right Heart Failure



Right Heart Failure

Definition: Inability of the heart to adequately

handle volume of blood returning from systemiccirculation

Systemic Venous Congestion

Enlargement of caudal vena cava

Visceral CongestionGeneralized hepatomegaly

3rd space fluid transudation

Canine - ascites predominatesFeline - pleural effusion predominates



CONGENITAL HEART

DISEASES

Congenital Heart Diseases



Congenital Heart Diseases

Pulmonic stenosis

Aortic stenosis

Patent ductus arteriosus

Tetrology of Fallot



Pulmonic Valvular Stenosis (PS)

Valvular > subvalvular >>supravalvular

Right heart enlargement(RVE +/- RAE)

Main Pulmonary Artery Segmen

(PAS) enlargement Normal to small pulmonary vess

Right heart failure



PULMONIC STENOSIS



Aortic Valvular Stenosis (AS)



Aortic Valvular Stenosis (AS)

Subvalvular lesion LVE, +\- LAE

Elongation of the cardiasilhouette

Bulge in 3:00 – 5:00 are

Increased prominence o

aortic archBulge in cranial waist(lateral)

Widening of 11:00 - 1:00area (VD/DV)

Radiographs may benormal

AORTIC STENOSIS



Patent Ductus Arteriosus (PDA)



Patent Ductus Arteriosus (PDA)

Shunt from aorta to PA LVE, LAE, LAuE

Aneurysmal dilatation ofproximal descending aorta

PAS enlargement

Normal to large pulmonaryvessels

Left heart failure



Tetralogy of Fallot



Pulmonic Stenosis

High VSD

Overriding Aorta

Right Ventricular

Hypertropy

Overridingaorta

PS VSD

RVH

Tetralogy of Fallot



RVE

Boot-shaped heart (corsabot )

Main PAS variablyenlarged

Small pulmonaryvessels

TETROLOGY OF FALLOT



COR SABOT



ACQUIRED HEART DISEASE

Heartworm Disease



Pulmonary arterialchanges

RVE, RAE

Enlarged PAS

Pulmonary infiltrates

PIE - like

PTE

Right heart failure

CANINE HEARTWORM

DISEASE



Feline Heartworm Disease



Endocardiosis



Atrioventricular (AV) valvular insufficiency

Left AV (mitral) valve - (MI)

Right AV (tricuspid) valve - (TI)

Right and Left AV valves (MI/TI)

Endocardiosis



Mitral Insufficiency (MI) LAE, LVE

Left heart failure

Tricuspid Insufficiency (TI) RAE, RVE Right heart failure

Right and Left AV Valves (MI/TI) Generalized cardiomegaly

Right and/or left CHF

Mitral and Tricuspid Insufficiency



Mitral and Tricuspid Insufficiency

Canine Dilated Cardiomyopathy



y p y

Generalized cardiomegaly

typically left side predominant

LAE and LAuE

Left, right or biventricular heart failure

Dilated Cardiomyopathy

with left heart failure



Feline Cardiomyopathy



y p y

Both dilated and hypertrophic forms

Cannot be definitively distinguished on surveyradiographs Non-selective angiocardiography Echocardiography



Feline Dilated Cardiomyopathy

with right heart failure



g



Feline Hypertrophic Cardiomyopathy



DISEASES OF THE

PERICARDIUM

Pericardial Effusion



Spherically enlarged, globoid cardiac silhouette

Lack of discreet chamber definition

Differentiate from generalized cardiomegaly

Right heart failure

Additional imaging

US

nonselective angiogram

Pericardial Effusion



Peritoneal-PericardialDiaphragmatic Hernia



Diaphragmatic Hernia

Gas-containing bowel loops Silhouette heart / cupola of diaphragm

"small liver”

Sternal deformity

Additional ImagingUltrasound

Contrast Studies

Upper GI

Pneumoperitoneum

Peritoneal - Pericardial

Diaphragmatic Hernia

cardiology rad.ppt

Documents