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DIAGNOSTIC IMAGING > Cardiovascular Radiology > Flashcards

Cardiovascular Radiology Flashcards

1
Q

How do you tell thoracic rads are good positioning

A

Vertebrae
Spinous processes (tear drop shaped)
centered on heart
image take at inspiration

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2
Q

What are the radiographic limitations

A

-Insensitive to heart chamber changes
-Nonspecific for diagnosis
-Mild enlargement debatable
-Phase of cardiac cycle can effect
-Rotation and degree of inspiration affects interpretation

Echocardiogram is the method of choice for evaluating and assessing anatomy, pathology, and function - includes individual chambers and part of vascularization

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3
Q

What are the benefits of radiology over Echo

A

Provides evaluation of pulmonary circulation as an indicator of cardiac function
-evaluates pulmonary vessels
-Evaluates pulmonary parenchyma
-Treatment Response (ex: cats with HCM)

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4
Q

What are you evaluating with the heart

A

-Size
-Chambers/vessels
-Apex location
-vessels (pulmonary)
-Lung prenchyma/ pleural space

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5
Q

How large is the normal dog’s heart?

A

2.5-3.5 intercostal spaces wide on lateral
breed variation

VD/DV: Half to 2/3 width of thorax or less
extensive breed variation

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6
Q

How large is the normal cat’s heart

A

2-2.5 ICS on lateral on lateral

VD/DV: approx 50% width of thorax on VD

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7
Q

Normal Dog’s heart on lateral is

A

2.5-3.5 intercostal spaces wide
extensive breed variation

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8
Q

Normal dog’s heart on VD/DV is

A

1/2 - 2/3 width of thorax
extensive breed variation

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9
Q

How do you take a vertebral heart sum in dogs

A

Draw your lines in short and long axis
take each line and measure parallel to the thoracic spine beginning at T4 veterbral body

Count the number of number of veterbrae caudally

Sum the number of vertebrae caudally

dogs normal 8.5-10.5

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10
Q

What is a dog’s normal VHS

A

8.5-10.5 vertebral bodies

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11
Q

What is a normal cat VHS

A

7.5 +/- 0.3 vertebrae

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12
Q

How should the cardiac apex be normally positioned

A

VD: apex positioned slightly to the left on midline

Lateral: apex adjacent to caudal sternum with adjacent fat outlines

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13
Q

what is the normal trachea relationship

A

deviates ventrally from the spine along course to heart base

*pushed dorsally by heart enlargement

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14
Q

On VD/DV, what is located at 11-1

A

aortic arch- primarily closer to 1:00

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15
Q

what cardiac chamber is located at midline

A

left atrium

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16
Q

On lateral, what is located in the cranial dorsal cardiac silhouette

A

Right atrium
aorta
main pulmonary artery

*Must use VD/DV to to distinguish further

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17
Q

On lateral, what is located in the caudal dorsal cardiac silhouette?

A

Left Atrium

sometimes have tracheobronchial lymph nodes there (tell apart from trachea being displaced dorsally with LA enlargement)

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18
Q

What are the radiographic findings of generalized cardiomegaly in the dog

A

1) Greater than 2/3 width of thoracic cavity (VD/DV)
2) Greater than 2.5 (cat) or 3.5 (dog) intercostal space on lateral view
3) Round shape to the heart +/-
4) Increased VHS (>10.5 dog)

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19
Q

What are the radiographic signs of left atrial enlargement

A

1) Straightening or rounding of caudo-dorsal heart margin / caudal waist (backpack sign)
2) Splitting of the mainstem bronchi (may compress- bowlegged cowboy)
3) Round opacity superimposed over caudal aspect of heart on VD (double opacity- apex)
summation of enlarged LA w rest of heart
4) Lateral: Left auricular bulge at 2-3oclock

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20
Q

Left Auricular bulges can be seen with left atrial enlargement, where is this seen

A

about 2-3 oclock on VD/DV

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21
Q

On lateral: what do you see that is enlarged with left atrial enlargement

A

Straightening or rounding of caudo-dorsal heart margin / caudal waist (backpack sign)

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22
Q

Where is the double opacity of left atrial enlargement seen

A

caudal aspect of heart on VD
-summation of enlarged LA with the rest of the heart

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23
Q

You will see bulge or round at 3-6:00 with_______

A

Left ventricular enlargement

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24
Q

What makes the heart taller on lateral

A

left ventricular enlargement (dorsal displaced trachea)

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25
Q

What are the radiographic findings of left ventricular enlargement

A

1) Lateral: heart taller (dorsally displaces the trachea)
2) Bulge/Rounding at 3-6 oclock

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26
Q

What are the clinical signs of right atrial enlargement

A

1) Lateral: Bulge in cranial-dorsal heart margin at the cranial waste
2) VD: Bulge at 9:00-11:00

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27
Q

What might cause right atrial enlargement in an older dog

A

Hemangiosarcoma
Tricuspid disease

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28
Q

On VD, what does a 9:00-11:00 bulge mean

A

right atrial enlargement

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29
Q

On VD, what does a 6:00-9:00 bulge mean

A

right ventricular enlargement

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30
Q

On lateral, where will the bulge with right atrial enlargement be

A

cranio-dorsal heart margin at the cranial waste

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31
Q

What are the radiographic findings of right ventricular enlargement

A

Lateral: Bulge at cranial ventral heart regions
Increased sternal contact
Elevated apex off sternum

VD: 6:00-9:00

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32
Q

What are the radiographic signs of aortic arch enlargement

A

Lateral: bulge at the cranial dorsal heart

VD/DV: bulge at 11:00-1:00 (close to mediastinum, noticed best on right side)

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33
Q

On lateral: where is the bulge with aortic arch enlargement

A

cranial dorsal heart

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34
Q

What does a bulge at 11-1:00 on VD tell you

A

aortic arch enlargement
-close to mediastinum, noticed best on the right side

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35
Q

On lateral: where will you see the bulge with MPA enlargement

A

cranial dorsal

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36
Q

What will you see with 1:00-2:00 bulge on VD

A

Main Pulmonary Artery enlargement

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37
Q

On lateral view, cranial lobe vessels should be ________________________

A

no larger than proximal 4th rib

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38
Q

On VD/DV: caudal lobe vessels should be measured ___________________________

A

after the 1st branch - no larger than the 9th rib

39
Q

Vessels seen end on will look like ___________
Airways seen end on will look like ___________

A

Vessels: nodule
Airways: lucent because they contain gas

40
Q

What is the most common congenital heart disease in dogs

A

PDA

41
Q

What is the most common congenital heart disease in cats

A

VSD

42
Q

What is the most common congenital heart disease in horses

A

VSD

43
Q

Characteristics of stenotic lesions

A

1) Increased resistance of L or R ventricular ejection
2) Increased ventricular pressure
3) Ventricular hypertrophy
4) Turbulent blood flow through stenotic area- high speed jet causes aneurysmal dilation of vessel downstream from narrowed area (may see bulge on radiograph)

44
Q

pulmoanry stenosis is common in

A

brachycephalic breeds

45
Q

What are the 2 valvular stenotic lesions

A

1) Subaortic Stenosis
2) Pulmonary Stenosis

46
Q

What are the radiographic signs of subaortic stenosis

A

1) Bulge at 11:00-1:00 (Aorta) - from turbulent blood flow

2) Large L Atrium (if secondary mitral dynsfunction)

3) L auricle

*Normal pulmonary vessels until MV dysfunction then can develop pulmoanry venous hypertension

47
Q

With Subaortic stenosis, the pulmonary vessels are normal until there is

A

MV dysnfunction
then they can develop pulmonary venous hypertension

48
Q

What breeds is subaortic stenosis commonly seen in

A

large breed dogs
german shephards
german short haired pointers
rottweiler
golden retriever
samoyed
others

49
Q

malformation of pulmonic valve, less commonly narrow outflow tract

A

pulmonic stenosis

50
Q

What are the 3 radiographic findings of pulmonic stenosis

A

1) Large MPA (1:00-2:00 on VD)
2) Right Ventricular enlargement (hypertrophy)
-elevation of apex on laterals
-increased sternal contact
-bulge at 6:00-9:00
3) Right atrial enlargement (9:00-11:00)

51
Q

T/F: with pulmonic stenosis, pulmonary vessels are usually normal

A

true- may be small due to decreased cardiac output

52
Q

With pulmonic stenosis, there is increased resistance to ejection leading to

A

R ventricular hypertrophy

53
Q

With pulmonic stenosis there is turbulent blood flow leading to

A

Dilation of main pulmonary artery

54
Q

What breeds commonly get pulmonic stenosis

A

-Brachycephalics (Bulldogs, Bostons)
-Terriers (Jack russel)
-Samoyed
-Labrador Retrievers

55
Q

What are valvular incompetence diseases

A

leaky or malformed AV valves (tricuspid and mitral) that leads to a volume overload due to leaky valve and increased blood in chambers
can develop early heart failure

56
Q

What do you see with mitral valve dysplasia

A

Left atrial enlargement +/- LV
may get pulmonary venous stenosis

57
Q

What breeds get mitral valve dysplasia

A

bull terriers
german shephards
great danes

58
Q

What are the radiographic findings of tricupsid valve dysplasia

A

1) Right atrial enlargement (9-11) from pressure and volume overload

2) Pulmonary vessels usually normal but can be small with decreased CO

59
Q

What breeds commonly get tricuspid valve dysplasia

A

labrador retreivers
german shepherds

60
Q

With shunting lesions, what should you look for

A

overperfused lung

most shunts are left to right so the right heart gets too much blood
leads to congestion/enlargement of the arteries and veins
see peripheral vessels better than usual because they are large
can progress to heart failure

61
Q

what breeds commonly get ventricular septal defects

A

english bulldog
springer spaniel

common in cats

62
Q

communication between the R and L ventricles, typically in membranous septum

A

Ventricular septal defect

63
Q

T/F: ventricular septal defects are easy to identify on radiographs

A

False- it is hard

Echocardiography is essential

64
Q

Ductus arteriosus connects the

A

aorta with the pulmonary artery

-bypasses the pulmonary circulation in the fetus
typically closes short after birth

65
Q

What occurs with the ductus arteriosus is patent

A

Increased L sided pressure so blood flows from aorta through PDA to MPA

PULMONARY OVERCIRCULAION

66
Q

What are the radiographic signs of ventricular septal defect

A

1) Variable heart enlargement (may look generalized depending on the size of the shunt)

2) Pulmonary overcirculation (Dilated A and Vein)
Abnormal lungs- ventral- interstitial

3) Bulge MPA

67
Q

What radiographic changes is seen with PDA

A

3 knuckle sign
1) Proximal Descending Aorta - enalrged from turbulent flow

2) MPA enlargement: Increased pressure and flow

3) Enlargement of LEft atrium and L auricle: increased blood flow

4) Enlarged left ventricle (initially dilation

5) Enlarged pulmonary artery and vein (increased flow and pressure)

68
Q

What is the 3 knuckle sign seen with PDA

A

1) Proximal Descending Aorta ~1:00
2) MPA (1:00-2:00)
3) L auricle (3:00)
+
generalized cardiomegaly
usualyl see 1-2 bulges (less commonly 3)

also see pulmonary overcirculation

69
Q

What murmur is seen with PDA

A

continuous murmur with washing machine murmur

70
Q

With the left side of the heart failing to push adequate blood into systemic circulation there is

A

increase LV pressure transmitted to the LA and pulmonary veins

veins get distended due to hypertension

fluid leaks from capillaries into the lungs (interstitial space then alveoli)

71
Q

What are the radiographic findings of left sided heart failure

A

1) Dilated pulmonary veins

2) Interstitial to Alveolar Pattern
-Caudodorsal common, more diffuse is possible, asymmetric

3) Eventually pulmonary arterial hypertension (not common on rads)

72
Q

What lung pattern is seen with left sided heart failure

A

Interstitial to Alveolar Pattern
caudodorsal is common

73
Q

What is your diagnosis if you see opaque lungs interstital to alveolar pattern that is worse caudodorsal and a heart murmur

A

left sided heart failure

74
Q

where do you typically see the lung pattern of left sided heart failure

A

caudodorsal

75
Q

systemic venous congestion due to abnormal right function
blood backs up to venous circulation (vena cava, liver, spleen)
eventually get peritoneal and pleural effusion

A

right sided congestive heart failure

76
Q

What are the radiographic signs of right sided congestive heart failure

A

large liver + spleen
liver rounded
free fluid in abdomen
enlarged CVC
pleural effusion

77
Q

What are the radiographic changes seen with mitral valve insufficiency

A

1) Left Atrial enlargement

2) Progresses to Left Ventricular Enlargement

3) Cough caused by
-compressed of left caudal lobar bronchus and left sided CHF

78
Q

What causes the cough seen with mital valve insuffiency

A

1) Left sided CHF
2) Compression of left caudal lobar bronchus

79
Q

How do dog with mitrial valve insufficiency typically present

A

middle age to older small breed dogs

respiratory difficulty, cough, murmur

80
Q

What dog breeds typically get dilated cardiomyopathy

A

large and giant
Doberman, great danes
boxer
cocker spaniel

81
Q

What are the radiographic signs of canine dilated cardiomyopathy

A

1) Generalized cardiomegaly
2) Left atrial dilation (volume overload or MV dysfunction)
3) Pulmonary vein dilation
4) Pulmonary artery dilation
5) CHF
L- interstitial and bronchial (more typical)
R- pleural and/or abdominal effusion, hepatomegaly

82
Q

heartworm disease affects any age over

A

6 months

83
Q

mature heartworms live in the

A

right outflow tract-> cause pulmonary arterial intimal thickening (inflammation and mechanical obstruction)

84
Q

What are the radiographic signs of heartworm disease

A

1) Main pulmonary artery enlargement - also from worms creating turbulent flow (1:00-2:00)

2) Right Ventricular Enlargement (hypertrophy)

3) Pulmonary arteries enlarged and tortuous

4) Pulmonary interstitial or alveolar pattern
-focal or multifocal to generalized
-local thromboemboli from worm fragments + focal pneumonitis/allergic response (eosinophilic bronchopneumopathy)

5) Possible R CHF

85
Q

Heartworm causes possible left or right side heart failure

A

R CHF

86
Q

What are the radiographic signs of pulmonary hypertension

A

1) Right Heart Enlargement
2) Large main pulmonary artery
3) Large tortuous pulmary arteries- can get pulmonary infiltrates

87
Q

What cat breeds commonly get HCM

A

Maine Coon
Ragdoll
British Shorthair
Sphynx
Chartreux
Persians

88
Q

What are the clinical signs of HCM

A

Murmur
Gallop
Dyspnea
Saddle thrombus

89
Q

What are the radiographic findings of HCm

A

1) Mild to Severe Left Atrial Enlargement

2) Generalized cardiomegaly- becomes bean shaped on lateral

3) Classic Valentine Shape on VD/DV (R+L atria look enlarged - but L atria is enlarged

4) Can develop L sided CHF
-Large Pulmonary veins
-Interstitial to Alveolar Pattern
-Pulmonary pattern more patchy
Later develop pleural effusion

Do an echo

90
Q

What might cause pericardial effusion in dogs

A

Right atrial masses
Idiopathic pericarditis

91
Q

What are the radiographic findings of pericardial effusion in dogs

A

1) Variable cardiomegaly

2) Classic globoid appearance (large round heart on both views)

3) Caudo-dorsal border shape and curved -> no LA bulge

4) May have concurrent pleural effusion

5) Abdominal manifestations of right heart failure
-Dilated CVC
-Hepato-splenomegaly
-Ascites

92
Q

What may cause a rightward and dorsal displacement of the trachea, cranial to the bifurcation
often laterally on VD/DV

A

Heart Base Masses

93
Q

How should you distinguish DCM from pleural effusion

A

ECHO

DIAGNOSTIC IMAGING (16 decks)

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