Plain Film Imaging of Heart Disease

Question 1

Ddx for enlarged heart

Answer 1

cardiomyopathy due to CHF, valvular regurgitation, high output/overload states, pericardial effusion, paracardiac mass

Question 2

key structures to evaluate for in cardiomegaly

Answer 2

left atrium, aorta

Question 3

enlarged left atrium + cardiomegaly

Answer 3

mitral regurgitation

Question 4

enlarged aorta + cardiomegaly

Answer 4

aortic regurgitation

Question 5

normal size heart with cardiovascular disease DDX

Answer 5

valvular stenosis (aortic/mitral), PAH, hypertrophic cardiomyopathy, restrictive physiology, acute MI

Question 6

key structures to evaluate with cardiac disease and normal size heart

Answer 6

left atrium, aorta

Question 7

normal size heart, enlarged left atrium

Answer 7

mitral stenosis

Question 8

aorta enlarged + normal size heart

Answer 8

aortic stenosis or aortic aneurysm

Question 9

right ventricular enlargement

Answer 9

displaces cardiac apex leftward; opacification of retrosternal clear space

Question 10

right atrial enlargement

Answer 10

lateral bulging or elongation of right heart border

Question 11

left ventricular enlargement

Answer 11

left heart border enlarged; displacement of apex in inferior/left direction

does not cause enlargement of external contour of ventricule in HOCM

Question 12

left atrial enlargement causes

Answer 12

mitral regurgitation (cardiomegaly) or with mitral stenosis (normal heart size)

Question 13

LEFT ventricular aneurysm

Answer 13

focal outpouching of wall with all layers of muscle affected; associated with occlusion of LAD

anterolateral/apical wall of LV, may calcify

abnormal contour of midportion of left cardiac border

Question 14

False aneurysm/pseudoaneurysm

Answer 14

contained ventricular ruption with pericardial adhesions preventing rupture; no myocardium

occlusion of circumflex or R coronary arteries

seen in upper diaphgragmatic/posterior wall; may increase in size and rupture

treat surgically

Question 15

Dressler syndrome

Answer 15

autoimmune pericarditis; associated with pericardial/pleural effusions

Question 16

causes of endocarditis

Answer 16

IV drug use, poor dental hygiene, diabetes, prosthetic valves

Question 17

diagnosis of endocarditis

Answer 17

echocardiography; CT if >1 cm in diameter; look for perivalvular abscess or extracardiac complications like septic PE

Question 18

how to evaluate prosthetic valves

Answer 18

on lateral view: sternal/diaphgragmatic junction and carina

tricuspid is right/anterior to mitral valve

pulmonic valve is superior/leftward

Question 19

mitral regurgitation

Answer 19

secondary to MI, acute pulmonary edema with normal size heart

can cause left atrial enlargement

Question 20

enlargement of left atrial appendage

Answer 20

seen with rheumatic disease; chronic mitral regurgitation

Question 21

mitral stenosis

Answer 21

normal heart size, left atrial enlargement; elevated pulmonary venous pressure

Question 22

mitral annular calcification

Answer 22

calcium deposited along fibrous annulus encircling mitral valve

increased risk of stroke, Afib, cardiovascular events

Question 23

aortic stenosis

Answer 23

LV hypertrophy, normal heart size; ascending aorta enlarged

Question 24

aortic regurgitation

Answer 24

LV enlargement + cardiomegaly

pulmonary vasculature normal

Question 25

right sided valvular disease

Answer 25

carcinoid disease; tricuspid/pulmonic valve dysfunction