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8/10/2019 cardiology rad.ppt
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RADIOLOGY OF THE
HEART AND GREATVESSELS
William H. Adams DVM
Associate Professor, Radiology
College of Veterinary Medicine
University of Tennessee
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NORMAL ANATOMY -
THE HEART
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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
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Normal Variants
Feline cardiac silhouette consistent
Canine cardiac silhouette varies widely
breed
size
body type
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Normal Feline
Lateral Projection
2 to 2.5 ICS wide
2/3 DV thoracic
diameter
Trachea deviates from
spine
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Normal Feline
VD/DV Projection
Apex slightly to left ofmidline
Broad convexity in areof right atrium and leftventricle
Flat left auricle area
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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
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Normal Canine
Deep-chested
Doberman, Collie
VD/DV projection circular to ovoid heart
apex median to slightly left of
midline
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Normal Canine
Intermediate German Shepherd Dog
Labrador Retriever
Lateral projection
3 intercostal spaces base angled craniodorsall
2/3 DV diameter
tracheal deviates from spi
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Normal Canine
Intermediate conformation German Shepherd Dog Labrado
Retriever
VD/DV projection
more elongated
apex to left
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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)
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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
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EVALUATION
OF THE
CARDIAC
SILHOUETTE
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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
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Lateral
Cranial border Dorsal 1/3 (cranial waist)
right auricle
ascending aortic arch
main pulmonary artery
Ventral 2/3wall of RV
pulmonary outflow tract
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Lateral
Caudal border
Caudal waist
Left atrium
Left ventricle
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Angiocardiography
Chamber size
Wall thickness
Valvularconformation
Transit time
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Angiocardiography
Non-selective
Contrast injection in peripheral vein
Selective
Catheter placement in area of interest Fluoroscopy
cardiac chamber
vessel
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Non-selective Angiogram
Indications
Valvular stenoses
Right to left shunts
Assess chamber size and wallthickness
Pericardial effusion
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Cardiomegaly
Most consistent indicator of heart disease
Wide range of normal
Mensuration techniques of questionable value
Diagnosis more secure as severity of changes
increases
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Left Atrial Enlargement (LAE)
Dorsal displacemeof main stem bron
Convexity of caud
waist
Increased size ofcaudodorsal borde
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Left Atrial Enlargement (LAE)
Double opacity sign
Separation of main stem
bronchi
"Bow-legged cowboy"
Left auricular
enlargement (LAuE)
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Left Ventricular Enlargement (LVE)
Dorsal displacement of thtrachea
Increase in proportion ofDV diameter of thorax
Straightening of caudalborder
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Left Ventricular Enlargement (LVE)
Elongation of cardiac
silhouette
Deviation of cardiac apex
to left
Increased prominence in
2:00 - 5:00 region
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Right Atrial Enlargement (RAE)
Lateral view
Dorsal Bowing of trachecranial to carina (J-sha
Convexity of cranial wa
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Right Atrial Enlargement (RAE)
VD/DV view Increased
prominence in 9:00 -
11:00 region
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Right Ventricular Enlargement (RVE)
Lateral view Increased width o
the cardiacsilhouette
Increasedconvexity ofcranial margin
Tracheal changesas in RAE
Right Ventricular Enlargement (RVE)
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Right Ventricular Enlargement (RVE)
VD/DV View
Increased
prominence in 5:00
- 9:00 region
"Reverse D" shape
Generalized Cardiomegaly
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Generalized Cardiomegaly
Combination of Roentgen signs involving bothleft and right cardiac chambers
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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
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Microcardia
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Microcardia
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NORMAL ANATOMY -
The Great Vessels
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Aorta
Generalized enlargement
Segmental enlargements
Aortic arch - 11:00 - 1:00 (VD, DV) Proximal descending aorta (ductus
arteriosus)
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Main Pulmonary Artery Segment
(PAS)1:00 - 2:00 region (VD, DV)
Associations
Pulmonary hypertension
Pulmonary outflow tract stenosis
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DISEASES OF THE HEART
AND GREAT VESSELS
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CONGESTIVE HEART FAILURE -
RADIOGRAPHIC DIAGNOSIS
Left Heart Fail re
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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
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Left Heart Failure
Veins > arteries Caudodorsal
Pulmonary infiltratenonstructured
interstitialperibronchial
alveolar
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Right Heart Failure
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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
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CONGENITAL HEART
DISEASES
Congenital Heart Diseases
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Congenital Heart Diseases
Pulmonic stenosis
Aortic stenosis
Patent ductus arteriosus
Tetrology of Fallot
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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
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PULMONIC STENOSIS
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Aortic Valvular Stenosis (AS)
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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
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Patent Ductus Arteriosus (PDA)
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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
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Tetralogy of Fallot
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Pulmonic Stenosis
High VSD
Overriding Aorta
Right Ventricular
Hypertropy
Overridingaorta
PS VSD
RVH
Tetralogy of Fallot
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RVE
Boot-shaped heart (corsabot )
Main PAS variablyenlarged
Small pulmonaryvessels
TETROLOGY OF FALLOT
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COR SABOT
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ACQUIRED HEART DISEASE
Heartworm Disease
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Pulmonary arterialchanges
RVE, RAE
Enlarged PAS
Pulmonary infiltrates
PIE - like
PTE
Right heart failure
CANINE HEARTWORM
DISEASE
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Feline Heartworm Disease
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Endocardiosis
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Atrioventricular (AV) valvular insufficiency
Left AV (mitral) valve - (MI)
Right AV (tricuspid) valve - (TI)
Right and Left AV valves (MI/TI)
Endocardiosis
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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
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Mitral and Tricuspid Insufficiency
Canine Dilated Cardiomyopathy
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y p y
Generalized cardiomegaly
typically left side predominant
LAE and LAuE
Left, right or biventricular heart failure
Dilated Cardiomyopathy
with left heart failure
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Feline Cardiomyopathy
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y p y
Both dilated and hypertrophic forms
Cannot be definitively distinguished on surveyradiographs Non-selective angiocardiography Echocardiography
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Feline Dilated Cardiomyopathy
with right heart failure
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g
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Feline Hypertrophic Cardiomyopathy
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Feline Hypertrophic Cardiomyopathy
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DISEASES OF THE
PERICARDIUM
Pericardial Effusion
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Spherically enlarged, globoid cardiac silhouette
Lack of discreet chamber definition
Differentiate from generalized cardiomegaly
Right heart failure
Additional imaging
US
nonselective angiogram
Pericardial Effusion
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Peritoneal-PericardialDiaphragmatic Hernia
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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
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