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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
What are the radiographic findings of left ventricular enlargement
1) Lateral: heart taller (dorsally displaces the trachea) 2) Bulge/Rounding at 3-6 oclock
26
What are the clinical signs of right atrial enlargement
1) Lateral: Bulge in cranial-dorsal heart margin at the cranial waste 2) VD: Bulge at 9:00-11:00
27
What might cause right atrial enlargement in an older dog
Hemangiosarcoma Tricuspid disease
28
On VD, what does a 9:00-11:00 bulge mean
right atrial enlargement
29
On VD, what does a 6:00-9:00 bulge mean
right ventricular enlargement
30
On lateral, where will the bulge with right atrial enlargement be
cranio-dorsal heart margin at the cranial waste
31
What are the radiographic findings of right ventricular enlargement
Lateral: Bulge at cranial ventral heart regions Increased sternal contact Elevated apex off sternum VD: 6:00-9:00
32
What are the radiographic signs of aortic arch enlargement
Lateral: bulge at the cranial dorsal heart VD/DV: bulge at 11:00-1:00 (close to mediastinum, noticed best on right side)
33
On lateral: where is the bulge with aortic arch enlargement
cranial dorsal heart
34
What does a bulge at 11-1:00 on VD tell you
aortic arch enlargement -close to mediastinum, noticed best on the right side
35
On lateral: where will you see the bulge with MPA enlargement
cranial dorsal
36
What will you see with 1:00-2:00 bulge on VD
Main Pulmonary Artery enlargement
37
On lateral view, cranial lobe vessels should be ________________________
no larger than proximal 4th rib
38
On VD/DV: caudal lobe vessels should be measured ___________________________
after the 1st branch - no larger than the 9th rib
39
Vessels seen end on will look like ___________ Airways seen end on will look like ___________
Vessels: nodule Airways: lucent because they contain gas
40
What is the most common congenital heart disease in dogs
PDA
41
What is the most common congenital heart disease in cats
VSD
42
What is the most common congenital heart disease in horses
VSD
43
Characteristics of stenotic lesions
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
pulmoanry stenosis is common in
brachycephalic breeds
45
What are the 2 valvular stenotic lesions
1) Subaortic Stenosis 2) Pulmonary Stenosis
46
What are the radiographic signs of subaortic stenosis
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
With Subaortic stenosis, the pulmonary vessels are normal until there is
MV dysnfunction then they can develop pulmonary venous hypertension
48
What breeds is subaortic stenosis commonly seen in
large breed dogs german shephards german short haired pointers rottweiler golden retriever samoyed others
49
malformation of pulmonic valve, less commonly narrow outflow tract
pulmonic stenosis
50
What are the 3 radiographic findings of pulmonic stenosis
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
T/F: with pulmonic stenosis, pulmonary vessels are usually normal
true- may be small due to decreased cardiac output
52
With pulmonic stenosis, there is increased resistance to ejection leading to
R ventricular hypertrophy
53
With pulmonic stenosis there is turbulent blood flow leading to
Dilation of main pulmonary artery
54
What breeds commonly get pulmonic stenosis
-Brachycephalics (Bulldogs, Bostons) -Terriers (Jack russel) -Samoyed -Labrador Retrievers
55
What are valvular incompetence diseases
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
What do you see with mitral valve dysplasia
Left atrial enlargement +/- LV may get pulmonary venous stenosis
57
What breeds get mitral valve dysplasia
bull terriers german shephards great danes
58
What are the radiographic findings of tricupsid valve dysplasia
1) Right atrial enlargement (9-11) from pressure and volume overload 2) Pulmonary vessels usually normal but can be small with decreased CO
59
What breeds commonly get tricuspid valve dysplasia
labrador retreivers german shepherds
60
With shunting lesions, what should you look for
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
what breeds commonly get ventricular septal defects
english bulldog springer spaniel common in cats
62
communication between the R and L ventricles, typically in membranous septum
Ventricular septal defect
63
T/F: ventricular septal defects are easy to identify on radiographs
False- it is hard Echocardiography is essential
64
Ductus arteriosus connects the
aorta with the pulmonary artery -bypasses the pulmonary circulation in the fetus typically closes short after birth
65
What occurs with the ductus arteriosus is patent
Increased L sided pressure so blood flows from aorta through PDA to MPA PULMONARY OVERCIRCULAION
66
What are the radiographic signs of ventricular septal defect
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
What radiographic changes is seen with PDA
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
What is the 3 knuckle sign seen with PDA
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
What murmur is seen with PDA
continuous murmur with washing machine murmur
70
With the left side of the heart failing to push adequate blood into systemic circulation there is
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
What are the radiographic findings of left sided heart failure
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
What lung pattern is seen with left sided heart failure
Interstitial to Alveolar Pattern caudodorsal is common
73
What is your diagnosis if you see opaque lungs interstital to alveolar pattern that is worse caudodorsal and a heart murmur
left sided heart failure
74
where do you typically see the lung pattern of left sided heart failure
caudodorsal
75
systemic venous congestion due to abnormal right function blood backs up to venous circulation (vena cava, liver, spleen) eventually get peritoneal and pleural effusion
right sided congestive heart failure
76
What are the radiographic signs of right sided congestive heart failure
large liver + spleen liver rounded free fluid in abdomen enlarged CVC pleural effusion
77
What are the radiographic changes seen with mitral valve insufficiency
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
What causes the cough seen with mital valve insuffiency
1) Left sided CHF 2) Compression of left caudal lobar bronchus
79
How do dog with mitrial valve insufficiency typically present
middle age to older small breed dogs respiratory difficulty, cough, murmur
80
What dog breeds typically get dilated cardiomyopathy
large and giant Doberman, great danes boxer cocker spaniel
81
What are the radiographic signs of canine dilated cardiomyopathy
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
heartworm disease affects any age over
6 months
83
mature heartworms live in the
right outflow tract-> cause pulmonary arterial intimal thickening (inflammation and mechanical obstruction)
84
What are the radiographic signs of heartworm disease
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
Heartworm causes possible left or right side heart failure
R CHF
86
What are the radiographic signs of pulmonary hypertension
1) Right Heart Enlargement 2) Large main pulmonary artery 3) Large tortuous pulmary arteries- can get pulmonary infiltrates
87
What cat breeds commonly get HCM
Maine Coon Ragdoll British Shorthair Sphynx Chartreux Persians
88
What are the clinical signs of HCM
Murmur Gallop Dyspnea Saddle thrombus
89
What are the radiographic findings of HCm
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
What might cause pericardial effusion in dogs
Right atrial masses Idiopathic pericarditis
91
What are the radiographic findings of pericardial effusion in dogs
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
What may cause a rightward and dorsal displacement of the trachea, cranial to the bifurcation often laterally on VD/DV
Heart Base Masses
93
How should you distinguish DCM from pleural effusion
ECHO

DIAGNOSTIC IMAGING (16 decks)

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