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Cardiac x rays
Mitral stenosis
X-Ray Findings of MS
o Cardiac Findings
? Usually normal or slightly enlarged cardio-thoracic ratio
? Straightening of left heart border
? Convexity of left heart border 2? to enlarged atrial appendage--
only in rheumatic heart disease
? Small aortic knob from decreased cardiac output
? Double density of left atrial enlargement
? Rarely, right atrial enlargement from tricuspid insufficiency
X-Ray Findings of MS-Pulmonary Findings
o Cephalization
o Elevation of left mainstem bronchus (especially if 90? to trachea)
o With severe, chronic disease enlargement of the main pulmonary
artery from pulmonary arterial hypertension
Mitral regurgitation
convexity or straightening of the left atrial appendage along the left
heart border below the main pulmonary artery due to left atrial
enlargement;
double density projecting over the right heart, reflecting
superimposition of enlarged left atrium over the right heart
elevation of the left main bronchus and splaying of the carina by
enlarged left atrium
left ventricular enlargement
cephalization of flow due to pulmonary venous hypertension
Pericardial effusion
Small pericardial effusions are often occult on plain film. Greater than 200 mL of
pericardial fluid is usually required to become radiographically visible.
Radiographic signs include:
there can be globular enlargement of the cardiac shadow giving a water bottle
configuration
lateral CXR may show a vertical opaque line (pericardial fluid) separating a vertical
lucent line directly behind the sternum (pericardial fat) anteriorly from a similar
lucent vertical lucent line (epicardial fat) posteriorly; this is known as the Oreo
cookie sign 5
widening of the subcarinal angle without other evidence of left atrial enlargement
may be an indirect clue 2
a differential density sign at cardiac borders has been suggested 9, but its
specificity is limited
serially enlarging cardiothoracic ratio
hemodynamic compromise may manifest with signs of cardiogenic pulmonary
edema
Pericardial calcification
Calcification in the pericardium is most likely inflammatory in nature
Can be seen with a variety of infections, trauma, and neoplasms
Calcification most commonly occurs along the inferior diaphragmatic surface of the
pericardium surrounding the ventricles
Thin, egg-shell like calcification is more often associated with viral infection or uremia
Calcification from old TB is often thick, confluent, and irregular in appearance, especial y when
compared with myocardial calcification
Calcification is seen in 1/3-1/2 of patients with constrictive pericarditisIts presence
does not imply constriction
Pericardial calcification must be dif erentiated from coronary artery calcification,
valvular calcification, calcified myocardial infarct or ventricular aneurysm, left atrial
calcification, or calcification outside the heart
This can usual y be accomplished by the locations of these calcifications on multiple
views, or the radiographic appearance of the calcium
This post was last modified on 12 August 2021