Chest Radiography

Question 1

“Water bottle” configuration occurs in what cases?

Answer 1

Pericardial effusion or generalized cardiomyopathy

Question 2

“Shmoo” configuration describes lengthening and rounding of the left heart border with a downward extension to the apex resulting from what circumstance?

Answer 2

Left ventricular enlargement

Question 3

“Straightening” of the left heart border is seen in what cases?

Answer 3

Rheumatic heart disease and mitral stenosis

Question 4

What is the second mogul?

Answer 4

Main pulmonary artery

Question 5

Excessive convexcity or concavity of the second mogul is seen in what cases?

Answer 5

Excessive convexity = poststenotic dilatation, chronic obstructive pulmonary disease, pulmonary arterial hypertension, left-to-right shunts, and pericardial defects

Severe concavity = suggests right-to-left shunt

Question 6

What is the the third mogul?

Answer 6

Prominent left atrial appendage that in 90% of cases indicates prior rheumatic carditis

Question 7

What is the fourth mogul?

Answer 7

It is a bulge just above the cardiophrenic angle, seen with infarction or ventricular aneurysm

Question 8

The fifth bulge at the cardiophrenic angle is caused by what?

Answer 8

Caused by pericardial cysts, prominent fat lads, or adenopathy

Question 9

Left atrial enlargement is best confirmed by measuring what?

Answer 9

By measuring the distance from the midinferior border of the left mainstem bronchus to the right lateral border of the left atrial density.

This distance is less than 7 cm in 90% of normal patients and is greater than 7 cm in 90% of patients with left atrial enlargement, as proven by echocardiography

Question 10

What is “atrial escape”?

Answer 10

Massive left atrial enlargement can result in the LA becoming border forming on the right side

Question 11

Walking man sign is seen on what cardiac chamber enlargement?

Answer 11

Left atrial enlargement

Question 12

Clues and sign to detect right atrial enlargement?

Answer 12

Prominent atrial bulge too far to the right of the spine (more than 5.5 cm from the midline on a well-positioned posteroanterio radiograph)

Elongation of the right atrial convexity to exceed 50% of he mediastinal or cardiovascular shadow

Right atrial enlargement usually accompanies right ventricular enlargement

Question 13

What is Hoffman-Rigler sign?

Answer 13

Seen in left ventricular enlargement

When the LV extends more than 1.8 cm posterior to the posterior border of the IVC at a level 2 cm cephalad to he intersection of the LV and IVC