Ch.9 - Recognizing Adult Heart Disease Flashcards

1
Q

Extracardial causes which can make the heart appear enlarged:

A
  1. AP portable studies.
  2. Factors which inhibit a deep inspiration.
  3. Abnormalities of the bony thorax.
  4. Presence of a pericardial effusion.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

On the lateral projection, the heart usually …?

A

Does not extend posteriorly to overlap the spine unless it is enlarged or there is a pericardial effusion.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

In an infant heart may normally be …?

A

65% of the cardiothoracic ratio.
Other factors should be assessed in an infant with apparent cardiomegaly such as the pulmonary VASCULATURE and the clinical signs/symptoms.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

The … is usually seen in infants superimposed on the upper portion of the cardiac silhouette and could mimic cardiac enlargement.

A

Thymus gland.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

2 patterns of CHF are:

A
  1. Pulmonary interstitial edema.

2. Pulmonary alveolar edema.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

4 key findings of pulmonary interstitial edema are:

A
  1. Thickening of the interlobular septa.
  2. Peribronchial cuffing.
  3. Fluid in the fissures.
  4. Pleural effusions.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

3 key findings in pulmonary alveolar edema:

A
  1. Fluffy, indistinct, patchy airspace densities.
  2. Bat-wing or butterfly configuration - frequently sparing the outer 3rd of the lungs.
  3. Pleural effusions, especially with cardiogenic pulm. edema.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Cardiogenic pulmonary edema is more likely to have:

A
  1. Pleural effusions.
  2. Kerley B lines.
  3. Cardiomegaly.
  4. Elevated capillary wedge pressure than non cardiogenic Pulm. Edema.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Non cardiogenic causes of pulm. Edema:

A

A diverse group of diseases:

  1. Uremia.
  2. DIC.
  3. Smoke inhalation.
  4. Near-drowning.
  5. Volume overload.
  6. Lymphangitic spread of malignancy.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Pulmonary HTN produces?

A

Pruning of the pulmonary vasculature and might be suspected when the main pulmonary artery achieves a diameter of 3cm or more on CT/MRI.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

The cardiac silhouette may appear enlarged for 3 main reasons:

A
  1. The heart is enlarged (cardiomegaly).
  2. Pericardial effusion mimics the appearance of cardiomegaly on conventional radiographs.
  3. Extracardiac factor produces APPARENT cardiac enlargement.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

In most normal adults at FULL inspiration, the cardiothoracic ratio is less than …%.

A

50%.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Normally, there are …-…mL of fluid in the pericardial space between the parietal and the visceral pericardial layers.

A

15-50mL.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

The DEPENDENT portion of the pericardial space is?

A

POSTERIOR TO THE LV.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Study of 1st choice in pericardial effusion is?

A

US.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

6 Extracardiac causes of APPARENT cardiomegaly:

A
  1. AP portable supine CXR - MCC.
  2. Suboptimal inspiration.
  3. Obesity/Pregnancy/Ascites –> Prevent inspiration.
  4. Pectus excavatum deformity.
  5. Rotation.
  6. Pericardial effusion.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Is it possible to estimate the size of the heart on a AP PORTABLE CXR?

A

Yes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

3 Tips about estimation of the heart size in AP PORTABLE CXR:

A
  1. If the LEFT heart border is touching the LEFT lateral chest –> Heart is enlarged.
  2. If the LEFT heart border is very close to the LEFT chest wall –> Heart is probably enlarged.
  3. If the heart is BORDERLINE enlarged on a portable AP CXR, it is probably NORMAL IN SIZE!
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

To evaluate for the presence of enlargement of the cardiac silhouette in the LATERAL projection, look at …?

A

The space posterior to the heart + Anterior to the spine at the level of the diaphragm.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

In a normal person, the cardiac silhouette will usually?

A

NOT EXTEND POSTERIORLY and project over the spine.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Recognizing cardiomegaly on an AP CXR:

A

Borderline enlarged –> Normal.
Significantly enlarged –> Enlarged.
Touching, or almost touching, the LEFT LATERAL CHEST WALL –> Definitely enlarged.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Cardiothoracic ratio may reach up to …% in infants and still be normal.

A

65%.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Also, in a child the … may overlap portions of the heart and sometimes mimic cardiomegaly.

A

Thymus gland.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Cardiac contours - Ascending aorta:

A

Should normally NOT project further to the right than the RIGHT HEART BORDER (ie right atrium).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Cardiac contours - Aortic knob:

A

Normally less than 35mm (measured from the edge of the air-filled trachea) and will normally push the trachea slightly to the right.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Cardiac contours - Normal left atrium:

A

Does NOT contribute to the border of the heart on a nonrotated frontal CXR.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Cardiac contours - Enlarged LA:

A

“Fills-in” and straightens the normal concavity just inferior to the main pulmonary artery segment and may sometimes be visible on the right side of the heart as well.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Cardiac contours - Descending aorta:

A

Parallels the spine and is barely visible on the frontal CXR of the chest.
–> When it becomes tortuous or uncoiled, it swings further away from the thoracic spine towards the patient’s left.

29
Q

The main pulmonary artery is usually:

A

Concave or flat.

In younger females it may normally be convex outward.

30
Q

Which are larger? The blood vessels at the apex or at the base of the lung in the upright position?

A

At the base, due to increased blood flow.

31
Q

What is the MC diagnosis in hospitalized patients over 65?

A

CHF.

32
Q

2 MCCs of CHF:

A
  1. CAD.

2. HTN.

33
Q

Typically, CHF presents with one of two radiographic patterns:

A
  1. Pulmonary interstitial edema.
  2. Pulmonary alveolar edema.
    There is overlapping.
34
Q

Pulmonary INTERSTITIAL edema has 4 KEY radiologic signs:

A
  1. Thickening of the interlobular septa.
  2. Peribronchial cuffing.
  3. Fluid in the fissures.
  4. Pleural effusions.
35
Q

Kerley B line:

A

Thickened interlobular septum.

36
Q

The interlobular septae are NOT detectable on a normal CXR but can become visible if they accumulate excessive fluid, usually at a PCWP of …?

A

15mmHg.

37
Q

Do the Kerley B lines actually exist?

A

Yes - At the lung bases, at or near the costophrenic angles.

38
Q

Kerley B lines - Characteristics:

A
  1. Very short (1-2cm long).
  2. Very thin (about 1mm).
  3. Horizontal in location.
  4. Usually extend to + abut the pleural surface.
39
Q

Chronic Kerley B lines?

A

After repeated episodes of pulmonary interstitial edema, the septal lines may FIBROSE.

40
Q

Kerley A lines:

A

Appear when connective tissue around the bronchoarterial sheaths in the lung distends with FLUID.

41
Q

Kerley A characteristics:

A

Extend from the hila for several cm (up to 6cm), BUT DO NOT REACH THE PERIPHERY.

42
Q

UNILATERAL pleural effusions from CHF are ALMOST ALWAYS?

A

Right-sided. (15% can be left-sided, but generally, this should point out to other diagnoses - metastases, TB, PE).

43
Q

When the PCWP is sufficiently elevated (about …), fluid spills out of the interstitium into the airspaces –> Pulmonary alveolar edema.

A

25mmHg.

44
Q

3 key findings in pulmonary alveolar edema:

A
  1. Fluffy, indinstict, patchy airspace densities.
  2. Bat-wing or butterfly configuration frequently sparing the outer 3rd of lungs.
  3. Pleural effusions are usually present when the edema is cardiogenic in origin.
45
Q

While most patients with CHF have an enlarged heart …?

A

Most patients with an enlarged heart are NOT in CHF.

–> In any individual, cardiomegaly itself is NOT a particularly sensitive indicator for the presence/absence of CHF.

46
Q

Define cephalization:

A

REDISTRIBUTION of flow in the lungs such that the UPPER LOBE pulmonary vessels become larger that the LOWER LOBE vessels –> Difficult to identify for most beginners.

47
Q

Non cardiogenic pulmonary edema - Causes:

A
  1. ARDS.
  2. Volume overload.
  3. Lymphangitic spread of malignancy.
  4. High-altitude pulmonary edema.
  5. Neurogenic pulmonary edema.
  6. Reexpansion pulmonary edema.
  7. Heroin or other overdoses.
48
Q

Characteristically, patients with ARDS are radiographically …?

A

NORMAL FOR 24-36hrs after the initial insult.

49
Q

The typical course of radiologic findings in ARDS:

A

Stabilize after 5-7 DAYS –> Begin improving in about 2 WEEKS –> Complete clearing, when it occurs, may take MONTHS.

50
Q

Differentiating cardiogenic from NON cardiogenic pulmonary edema?

A

From the patients HISTORY + CLINICAL PICTURE.

51
Q

Chronic elevation of systemic blood pressure leads to LVH in about …% of patients (double that incidence if the patient is obese).

A

20%.

52
Q

The aorta, under increased systemic pressure?

A

Pivots outward around the aortic valve and the aortic hiatus in the diaphragm + gradually UNCOILS –> Becoming more prominent in BOTH its ascending and descending PORTIONS.

53
Q

Mitral valve stenosis - What to see?

A

CEPHALIZATION –> UPPER LOBE vessels become as large as or more prominent that LOWER LOBE vessels.

54
Q

What is the leading cause of death in primary pulmonary HTN?

A

Progressive RHF.

55
Q

What is the HALLMARK of pulmonary arterial HTN?

A

A discrepancy in size between the central pulmonary vasculature + the peripheral pulmonary vasculature.
–> PRUNING.

56
Q

On CT, the main pulmonary artery is normally about the SAME diameter as the ASCENDING aorta, but in pulmonary arterial HTN?

A

The main pulmonary artery is usually 3cm or larger in size.

57
Q

Radiographic findings in aortic stenosis:

A
  1. Heart is usually normal in size.

2. Ascending aorta may be unusually prominent because of post-stenotic dilatation –> HALLMARK.

58
Q

DCM - Best study is?

A

MRI –> Can provide the most accurate + reproducible findings for this disease.

59
Q

Why is it important to differentiate between constrictive pericarditis and restrictive cardiomyopathy?

A

Because constrictive pericarditis –> Is surgically curable.

60
Q

Which study can demonstrate the thickness of the pericardium?

A

MRI (normal is

61
Q

Aneurysms of the ASCENDING aorta?

A

May extend anteriorly + and to the right.

62
Q

Aneurysms of the AORTIC ARCH produce?

A

A MIDDLE mediastinum mass.

63
Q

Aneurysms of the DESCENDING aorta project?

A

Posteriorly, laterally, and to the left.

64
Q

What is the modality most often used to diagnose a thoracic aortic aneurysm?

A

Contrast-enhanced CT. (MRI is also excellent, but expensive and not always available).

65
Q

Aortic dissection - Radiologic findings:

A
  1. Widening of the mediastinum (Poor reliability - 25% OF CASES).
  2. Left pleural effusion - Also may produce a HEMOTHORAX.
  3. Left apical pleural cap of fluid or blood.
  4. Loss of the normal shadow of the aortic knob.
  5. Increased deviation of the trachea or esophagus to the RIGHT.
66
Q

Basic cardiac MRI terms - The 3 main cardiac imaging planes, called “Double oblique” views, are designed to best demostrate cardiac anatomy. They are:

A
  1. Short axis view.
  2. Horizontal long access –> 4-chamber view.
  3. Vertical long access –> 2-chamber view.
67
Q

Basic cardiac MRI terms - Cardiac function:

A

Usually evaluated using MRI sequences producing “bright blood” images because the blood is depicted with increased signal density.

68
Q

Basic cardiac MRI terms - Cardiac morphology:

A

Usually evaluated using MRI sequences producing “BLACK BLOOD” images –> Anatomic assessment of the cardiac structures without interference from the bright blood signal.

69
Q

In normal adults the cardiothoracic ratio is usually …%

A

<50%.