Radiology Of The Heart And Great Vessels

Front 1

4 Reasons for Cardiac Radiography

Back 1

1) Confirm clinical suspicion and severity of cardiac disease
2) Check for evidence of heart failure
3) Assess changes in cardiac size over time
4) Assess response to treatment by improvement or progression of the disease

Front 2

Positioning for Cardiac Radiography

Back 2

Usually make DV and either lateral view

Front 3

2 Benefits of DV vs VD When Radiographing the Heart

Back 3

1) Usually shows caudal vessels and parenchyma better
2) Shows heart in a more normal anatomic position

Front 4

Drawback of DV vs VD When Radiographing the Heart

Back 4

Middle and cranial lobes may not be as clear

Front 5

2 Differences in the Later Views of the Heart

Back 5

1) Right lateral has a heart egg shaped and left lateral has a more rounded heart
2) Left lateral allows better visualization of right cranial lobar vessels

Front 6

Deep-Chested Dog Breed Variations

Back 6

- Tall, thin thorax
- Breeds: Greyhound, Irish Setter, Borzoi, Poodle
- Generally a taller, narrower heart

Front 7

Barrel-Shaped Dog Breed Variations

Back 7

- Short, round
- Breeds: Chihuahuas, Shih Tzu, Dachshund, Basset, Pug, Terriers
- Generally a shorter, rounder heart

Front 8

3 Parts Included in the Cardiac Silhouette

Back 8

1) Heart
2) Pericardium and contents (fat)
3) Some adjacent mediastinum

Front 9

2 Rules of Thumb for Canine Heart Size

Back 9

1) 2.5 to 3.5 intercostal spaces on lateral
2) About 2/3 of the thoracic height (lateral) or width (VD/DV)

Front 10

3 Rules of Thumb for Feline Heart Size

Back 10

1) 2 intercostal spaces on lateral
2) About 2/3 of the thoracic height (lateral) or width (VD/DV)
3) Cat heart may lie more parallel to sternum

Front 11

7 Considerations for Vertebral Heart Scale

Back 11

1) Good for monitoring disease progress
2) Measure height from hilus to apex
3) Width is take at the base
4) Measure T4 caudally
5) Pitfall is breed variations (Boxers)
6) Dog is 8.7 to 10.7
7) Cat is 6.9 to 8.1

Front 12

9-11 o'clock on Lateral View

Back 12

1) Aorta
2) Main pulmonary artery
3) Right atrium

Front 13

12-2 o'clock on Lateral View

Back 13

1) Left atrium

Front 14

5-9 o'clock on Lateral View

Back 14

1) Right ventricle

Front 15

2-5 o'clock on Lateral View

Back 15

1) Left ventricle

Front 16

11-1 o'clock on VD/DV View

Back 16

1) Cranial mediastinum

Front 17

12-2 o'clock on VD/DV View

Back 17

1) Aorta
2) Main pulmonary artery

Front 18

1-3 o'clock on VD/DV View

Back 18

1) Left Auricle

Front 19

3-6 o'clock on VD/DV View

Back 19

1) Left ventricle

Front 20

5 o'clock on VD/DV View

Back 20

1) Caudal mediastinum

Front 21

7 o'clock on VD/DV View

Back 21

1) Caudal vena cava

Front 22

6-11 o'clock on VD/DV View

Back 22

1) Right heart

Front 23

Sign of Left Heart Failure

Back 23

Pulmonary edema

Front 24

4 Signs of Right Heart Failure

Back 24

1) Pleural effusion
2) Hepatomegaly
3) Ascites
4) +/- large caudal vena cava

Front 25

2 Conditions Causing Microcardia

Back 25

1) Conditions creating hypovolemia
2) Constrictive pericarditis (rare)

Front 26

4 Conditions Creating Hypovolemia

Back 26

1) Hypovolemic shock
2) Hemorrhage
3) Dehydration
4) Addison's disease

Front 27

2 Conditions Mimicking a Small Heart

Back 27

1) Emaciated animals
2) Lung hyperinflation with emphysema or excessive ventilation

Front 28

What is the most common cardiac enlargement?

Back 28

Left atrial enlargement

Front 29

2 Radiographic Signs of Left Atrial Enlargement on the Lateral View

Back 29

1) Bulging of the caudodorsal heart border at 12-2 o'clock
2) May see compression/narrowing of a caudal bronchus (normally the left)

Front 30

4 Radiographic Signs of Left Atrial Enlargement on the VD/DV View

Back 30

1) Increased size and opacity in area of left atrium
2) "Double wall"
3) Diverging caudal mainstem bronchi (VD)
4) +/- bulge at 1-3 o'clock on VD - left auricle

Front 31

3 Major Causes of Left Atrial and Left Ventricular Enlargement

Back 31

1) Volume overload
2) Pressure overload
3) Myocardial disease

Front 32

3 Causes of Volume Overload Leading to LA Enlargement

Back 32

1) Mitral regurgitation most common (endocardiosis most common, endocarditis and dysplasia)
2) PDA (L to R)
3) VSD (L to R)

Front 33

Cause of Pressure Overload Leading to LA Enlargment

Back 33

Mitral stenosis

Front 34

2 Causes of Myocadial Disease Leading to LA or LV Enlargment

Back 34

1) DCM in dogs
2) HCM in cats

Front 35

3 Radiographic Signs of Left Ventricular Enlargement on Lateral Views

Back 35

1) Elevation of the trachea
2) "Tall" heart
3) Trachea converges with spine

Front 36

Radiographic Sign of Left Ventricular Enlargement on DV/VD View

Back 36

Decreased distance between left heart border and chest wall

Front 37

4 Causes of Volume Overload Leading to LV Enlargement

Back 37

1) Mitral insufficiency
2) Aortic insufficiency
3) PDA
4) VSD

Front 38

2 Causes of Pressure Overload Leading to LV Enlargement

Back 38

1) SAS/AS (probably won't see enlargement early)
2) Systemic hypertension

Front 39

2 Radiographic Signs of Right Atrial Enlargement on Lateral Views

Back 39

1) Bulge or mass effect at craniodorsal aspect of the heart (9-11 o'clock)
2) +/- tracheal elevation

Front 40

Radiographic Sign of Right Atrial Enlargment of VD/DV

Back 40

Prominent craniodrosal heart border at 9-11 o'clock region

Front 41

3 Main causes of Right Atrial Enlargement

Back 41

1) Volume overload
2) Pressure overload
3) Right atrial tumor

Front 42

2 Causes of Volume Overload Leading to RA Enlargement

Back 42

1) Tricuspid insufficiency
2) Atrial septal defect (ASD)

Front 43

Cause of Pressure Overload Leading to RA Enlargement

Back 43

Tricuspid stenosis

Front 44

2 Radiographic Signs of Right Ventricular Enlargement on Lateral Views

Back 44

1) Increased sternal contact (watcho out for old cats)
2) Apex elevated from sternum

Front 45

3 Radiographic Signs of Right Ventricular Enlargement on VD/DV Views

Back 45

1) Rounding of right heart border
2) Reverse "D" shape
3) Apex may be shifted to the left

Front 46

2 Main Causes of Right Ventricular Enlargement

Back 46

1) Volume overload
2) Pressure overload

Front 47

4 Causes of Volume Overload Leading to RV Enlargement

Back 47

1) Tricuspid insufficiency
2) Pulmonic insufficiency
3) ASD
4) VSD

Front 48

5 Causes of Pressure Overload Leading to RV Enlargement

Back 48

1) Pulmonic stenosis
2) HWD
3) Pulmonary hypertension
4) Reverse PDA
5) Tetralogy of Fallot

Front 49

3 Causes for Large-Basketball Shape

Back 49

1) DCM
2) Pericardial effusion
3) Peritoneal Pericardial Diaphragmatic Hernia (PPDH)

Front 50

4 Radiographic Signs for Generalized Cardiomegaly

Back 50

1) May retain some normal shape
2) DCM with large left atrium and ventricle
3) Mild pericardial effusion
4) Advanced mitral and tricuspid disease

Front 51

3 Factors in Assessing the Caudal Vena Cava

Back 51

1) Extremely variable in size --> depends on stage of cardiac cycle and respiration
2) Normally slightly smaller than aorta
3) Consider enlargement if > 1.5X aorta

Front 52

2 Causes for Caudal Vena Cava Enlargement

Back 52

1) Right heart failure
2) Caval thrombosis

Front 53

3 Factors in Assessing the Aorta

Back 53

1) Can usually follow left margin from diaphragm to cranial mediastinum
2) 11-1 o'clock on VD
3) May be tortuous and have cranial bulge (VD) in cats

Front 54

3 Causes of Aorta Enlargement

Back 54

1) SAS/AS
2) PDA
3) Systemic hypertension

Front 55

Main Pulmonary Artery on Clock

Back 55

1) 1-2 o'clock on VD/DV

Front 56

3 Causes of Main Pulmonary Artery Enlargement

Back 56

1) Pulmonic stenosis
2) HWD
3) PDA

Front 57

3 Radiographic Signs of Left Heart Failure in Dogs

Back 57

1) Starts in the perihilar/dorsal region and radiates out
2) Hallmark is pulmonary edema
3) Peribronchial, patchy interstitial or alveolar lung pattern (or a mixture)

Front 58

2 Radiographic Signs of Left Heart Failure in Cats

Back 58

1) May look like anything - symmetric or assymetric, patchy, diffuse or central or may also have pleural effusion
2) Hallmark is pulmonary edema

Front 59

4 Acquired Causes of Heart Failure

Back 59

1) Mitral insufficiency
2) Heartworm disease
3) Cardiomyopathies
4) Pericardial effusion

Front 60

6 Congenital Causes of Heart Failure

Back 60

1) PDA
2) PS
3) SAS/AS
4) VSD
5) Mitral dysplasia
6) Tricuspid dysplasia

Front 61

5 Main Points on Heartworm Disease

Back 61

1) RV hypertrophy from pulmonary hypertension
2) Main pulmonary artery bulge
3) Parenchymal pulmonary artery dilation, tortuosity
4) Various lung parenchymal changes
5) Signs of right heart failure with progression

Front 62

3 Causes of Main Pulmonary Artery Bulge

Back 62

1) Turbulent flow
2) Pulmonary hypertension
3) Presence of HW

Front 63

2 Lung Parenchymal Changes with Heartworm Disease

Back 63

1) Interstitial/alveolar infiltrate (PIE, worm embolism)
2) Bronchial markings (allergic)

Front 64

4 Signs of Right Heart Failure from HWD

Back 64

1) Ascites
2) Pleural effusion
3) CaVC enlargement
4) Hepatomegaly

Front 65

3 Main Points on DCM

Back 65

1) Large and giant breed dogs
2) Rare in cats
3) Wide spectrum of radiographic signs

Front 66

4 Radiographic Signs of DCM

Back 66

1) Normal
2) Various cardiomegaly (certain chambers or general)
3) +/- pulmonary edema
4) +/- pleural effusion, ascites

Front 67

7 Main Points on HCM

Back 67

1) Cats
2) Rare in the dog
3) Moderate to severe LA enlargement
4) LV may appear enlarged
5) +/- pulmonary venous enlargement
6) +/- pulmonary edema
7) Pleural effusion if severe

Front 68

4 Main Points on Pericardial Effusion

Back 68

1) Idiopathic
2) Medium to large breed dogs
3) < 6 years
4) Heart may retain some shape or look like a basketball depending on severity

Front 69

4 Causes of Pericardial Effusion

Back 69

1) Neoplasia
2) Inflammatory/infectious pericarditis
3) PPDH
4) Vasculitis

Front 70

3 Main Points on PDA

Back 70

1) Failure of closure of the ductus arteriosus
2) Shunting of blood from aorta to MPA
3) Overcirculates the lungs and left heart

Front 71

3 Radiographic Signs of PDA

Back 71

1) Left volume overload --> LA and LV enlargement
2) +/- pulmonary vascular enlargement
3) Ductus bump (aorta and/or MPA)

Front 72

2 Main Point on Pulmonic Stenosis

Back 72

1) Valvular or infundibular stenosis
2) Right side pressure overload

Front 73

3 Radiographic Signs of Pulmonic Stenosis

Back 73

1) RV enlargment
2) MPA bulge
3) Peripheral pulmonary vessels might be small

Front 74

3 Main Points of Subaortic Stenosis/Aortic Stenosis

Back 74

1) Almost always SAS
2) AS in Bull Terriers
3) Left side pressure overload

Front 75

3 Radiographic Signs of SAS/AS

Back 75

1) LV enlargement - hypertrophy may not be evident until later in disease course
2) Aortic bulge
3) Possible LA enlargement if consequent or concurrent mitral valve disease

Front 76

4 Main Points on VSD

Back 76

1) Usually high septal defect --> blood shunts immediately into MPA --> left cardiomegaly due to overcirculation
2) Cardiac changes depend on size and location of VSD and other defects
3) May see right cardiomegaly
4) Usually overciculation of pulmonary vasculature

Front 77

3 Radiographic Signs of ASD

Back 77

1) Right heart enlargement due to overcirculation
2) +/- dilated MPA
3) +/- pulmonary overcirculation

Front 78

3 Main Points on Mitral Dysplasia

Back 78

1) Young patients (heart looks like old patient with MR)
2) Regurgitation is the effect
3) Radiographic signs are the same as acquired mitral insufficiency

Front 79

3 Radiographic Signs of Mitral Dysplasia

Back 79

1) LA enlargement
2) LV enlargement
3) +/- left heart failure (pulmonary edema)

Front 80

2 Main Points on Tricuspid Dysplasia

Back 80

1) Young patients
2) Regurgitation is the effect

Front 81

3 Radiographic Signs of Tricuspid Dysplasia

Back 81

1) RA enlargement
2) RV enlargment
3) +/- right heart failure