心脏病X线诊断ABC

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1、WhatItIs•Anapproach•Forcongenitaloracquiredheartdiseaseinadults•Askingsystematicsetofquestions•Answersbasedoncertainfundamentalobservations•Visibleonfrontalchestx-rayaloneOneoftheeasiestobservationstomakeissomethingyoualreadyknow:thecardio-thoracicratiowhichisthewid

2、estdiameteroftheheartcomparedtothewidestinternaldiameteroftheribcageSometimes,CTRismorethan50%ButHeartisNormalExtracardiaccausesofcardiacenlargement■PortableAPfilms■Obesity■Pregnant■Ascites■Straightbacksyndrome■PectusexcavatumHereisaheartthatislargerthan50%ofthecard

3、iothoracicratio,butitisstillanormalheart.Thisisbecausethereisanextracardiaccausefortheapparentcardiomegaly.Onthelateralfilm,thearrowspointtotheinwarddisplacementofSometimes,CTRislessthan50%ButHeartisAbnormal•Obstructiontooutflowoftheventricles■Ventricularhypertrophy

4、•MustlookatcardiaccontoursHereisanexampleofaheartwhichislessthan50%oftheCTRinwhichtheheartisstillabnormal.Thisisrecognizablebecausethereisanabnormalcontourtotheheart(yellowarrows).AorticknobIlE>aiacGeftvenndingAortaThereare7contourstotheheartinthefrontalprojectionin

5、thissystem,but...Ubledensity”kenlargementainpulmonaflartery、IndentationfiAorticknob.Mainpulmonaikartery、Indentation■Lla】ightatriumKAlightatriumhetopfivearereallyimportantinmakingadiagnosis・Theascendingaortacanbesmallasintheexampleontheleftorprominent,asintheexample

6、ontheright.Theascendingaortashouldnorprojectfarthertotherightthantherightheartbordernormally.Eventhoughweareontherightsideoftheheart,wecanseeleftatrialenlargement.Normallytheleftatriumsitsrightinthemiddleoftheheartposteriorlyanddoesnotformanormalborderonthefrontalfi

7、lmWhentheLAenlarges,itwilldosomethingontheleftsideoftheheartwelltalkaboutinaminute.Anditmayproducea“double-density”ontherightsideoftheheart.Thefirstbumpontheleft-sideistheaorticarch・Wecanmeasuretheknobfromthelateralborderofairinthetracheatotheedgeoftheaorticknob・pon

8、aryAorticknobMainPulmonaryArtery©theMainpulmonaryarteryLeftpularteryYouhavetobeabletofindthemainpulmonaryartery(MPA).Therearetwoways.(1)It