Hi Casey –

I will introduce the concept of how to read a frontal CXR using the Notes Scales and Music approach

Your part will be to apply the concept as to how to diagnose cardiomegaly – global and then each of the chambers as below

There should be no need to go to any of the links – You should be able to demo from this site

This is the basic outline of the lesson

1. 1. Is the heart enlarged?
   2. Border forming structures on the frontal
   3. Elemental shape difference between LVE and RVE
   4. LVE example is a little subtle but the point to make- need both frontal and lateral sometimes to make the decision of enlargement or not
   5. Triangular heart examples
      1. Mitral Stenosis
      2. Pulmonary Hypertension
   6. Enlarged LA – Very important since in so many cases it is a marker of CHF  So the carinal angle is really an important structure to look for when deciding if there is CHF  I find it one of the most useful signs of CHF
   7. RA enlargement – needs to be quite enlarged to appreciate
   8. If you have time last case of CHD and frontal CXR is fun

First step – Is the heart enlarged?

• Cardiothoracic ratio as a global method

Cardiothoracic Ratio

Border Forming Parts of the Heart

FRONTAL CXR AND PARTS OF THE HEART

Two Basic Shapes of Cardiomegaly

• • Oval down and outer of LV
  • Triangular RV disease
• Each of the Chambers
• LA, LV, RA, V

CARDIOMEGALY – TWO BASIC TYPES -OVOID and TRIANGULAR
The ovoid form which suggests left ventricular dominance and triangular form which suggests right ventricular dominance.
Ashley Davidoff MD

LVE

Subtle Ovoid Form Suggestive on the PA and Confirmed on the Lateral – Using Both Views

 

Triangular Heart with RVE

With Mitral Stenosis

With Pulmonary Hypertension

The Enlarged Left Atrium

Widened Carinal Angle

Double Density

Straightened right Heart Border – prominent LA appendage

Triangular Heart

 

Right Atrial Enlargement

• • enlarged, globular heart
  • narrow pedicle
  • gross enlargement of the right atrial shadow, i.e. increased convexity in the lower half of the right cardiac border
    • right atrial convexity is more than 50% of the cardiovascular height
    • right atrial margin is more than 5.5 cm from the midline

RIGHT ATRIAL ENLARGEMENT ON FRONTAL X-RAY
The right atrium is the most difficult chamber to assess unless it is very large in which case it will present on the frontal CXR with a very large right paravertebral border. This is a 71 year old female person with rheumatic heart disease with pulmonary hypertension and tricuspid regurgitation hence resulting in a large right atrium (RAE)
Ashley Davidoff MD

If there is time you may want to run through the  collage of congenital heart disease cases

 

The Shapes of the Heart in Health and Disease

From top left ti right and across the rows they are:  The normal heart , the “football” of LV enlargement the “triangle” or “proud breast” of RV enlargement, “snowman” of total anomalous pulmonary venous return,  big PA mogul of pulmonary hypertension,  “egg on its side” of D transposition of the great vessels,   “boot shaped” heart seen in both pulmonary atresia and Tetralogy of Fallot, the long smooth combined Ao and PA mogul that has a differential diagnosis of L transposition, absence of the pericardium, and juxtaposition of the atrial appendages, the box shaped large heart of Ebstein’s anomaly, dextrocardia , and the water bottle” heart of a large pericardial effusion.

07197 Images are  a combination of images from a personal collection and borrowed from the internet for educational purposes only. Some of the  sources are unknown and are used for educational  purposes alone 86774b02

 

TCV Links for extra info

 

Frontal CXR and Cardiomegaly 

Next  Cynthia Greene,