Chest X-Ray of Heart Failure

Question 1

With stage 1 of heart failure, what is the appearence on a CXR?

Answer 1

• Redistribution of the pulmonary vessels (Blood flows backwards into pulmonary veins which causes them to be increased in opacification.
• Cardiomegaly

Question 2

With stage 2 of CHF, what is the appearence on a CXR?

Answer 2

• Interstitial oedema: Kerley B lines, peribronchial cuffing (increased thickness of bronchial wall), hazy contours of vessels and thickened interlobular fissures

Question 3

With stage 3 of CHF, what is the appearence on a CXR?

Answer 3

• Alveolar oedema: consolidation, air bronchogram, cotton wool appearence (alveolar oedema) and plural effusion

Question 4

What is the bat sign?

Answer 4

Perihilar consolidation

Question 5

What defines cardiomegaly?

Answer 5

When the heart shadow takes up more than 50% of thorax

Question 6

Where are kerley B lines best seen?

Answer 6

low down on chest x ray

Question 7

Describe pleural effusions

Answer 7

• Occurs when a transudate or exudate fluid fills between thee parietal and visceral layers of the pleura.
• Can appear as a meniscus sign.
• Requires at least 175ml of fluid to be present for it to appear on an PA CXR.
• In congestive HF, 90% of plural effusions are bilateral