1. Imaging of cardiovascular system

2. Imaging technique Plain CXR :PA & lateral view Echocardio-study
Radioisotop scan
Computed tomography
MRI
Cardiac cartheritization & angiography.

4. What t observe Size & shape of the heart Pulmonary vessels Aorta.
lungs

7. Cardiac enlargement
Hear size usually measured on plain CXR by Cardiothoracic ration ,Normal ratio is less than 50%.
On serial CXR more than 1.5cm changes in widest cardiac daim. indicated cardiomegaly.

8. Pulmonary vascular pattern
Normal
Increase pul. blood flow(pulmonary plethora). Due to Lt.-Rt shunt
decrease pul. blood flow(pulmonary oligemia). Ex. TOF
Pul. Venous hypertension .
upper zone vessels equal or enlarge than lower zone vessels
Pulmonary edema.
5. Pul. arterial hypertension”
Causes:
Core pulomale
Pul. Embloi
Mitral valve disease, or LT.-RT shunt.
idiopathic
Features:
enlargement of pulmonary A.& hilar arteries

13. Global heart enlargements
Pericarditis
Cardiomyopathy
Heart failure
CXR
PA view increase C/T ratio
Lat. decrease in size of retrocardiac & retrosternal spaces , backward displacement of esophagus

14. Heart failure Cardiac enlargement+/- selective chamber enlargement
Increased pulmonary venous pressure ( increase vasculairty in upper lung zones)
Pulmonary edema
pleural effusion. usually bilateral RT. Larger than LT. but if unilateral its s almost always Rt.side.

15. LEFT ATRIAL ENLARGEMENT
Causes
Mitral stenosis/ regurgitation
LVF
LA myxoma
VSD
PDA

16. PA CXR Double right heart border
>75° splaying of carina with horizontal orientation of left main bronchus
Enlarged left convex left atrial appendage
Increased density of chamber
>7 cm distance between left main stem bronchus and right lateral LA shadow

18. >7 cm distance between left main stem bronchus and right lateral LA shadow

19. >75° splaying of carina with horizontal orientation of left main bronchus

20. Doube right heart border

22. LAT. CXR Increased convexity of posterio-superior cardiac margin
Posterior displacement of left main bronchus
Posterior displacement of barium filled esophagus

24. RIGHT ATRIAL ENLARGEMENT
Tricuspid stenosis/ regurgitation
ASD AF
Ebstein anomaly
Pulmonary atresia

25. PA CXR Increase in curvature of RT heart border.
Prominent round superior border at junction with SVC
>5.5 cm from midline to most lateral RA margin
>2.5 cm from right vertebral margin

27. LEFT VENTRICULAR ENLARGEMENT
Pressure overload: Hypertension , AS
Volume overload: VSD, AR, MR
Aneurysm
Cardiomyopathy

28. PA CXR Enlarges in post, inferior and leftward direction
Increased Cardiothoracic ratio
Larger radius of curvature of left heart border
Downturned cardiac apex
Depression of left hemidiaphragm

31. LAT. CXR Increased convexity of posteroinferior cardiac margin
Hofman rigler rule: posterior cardiac margin projects >1.8 cm post to IVC measured at a point 2cm above intersection of IVC with right hemidiaphragm

33. RIGHT VENTRICULAR ENLARGEMENT
PV stenosis
Cor pulmonale
ASD
Tricuspid regurgitation
Secondary to LVF

34. PA CXR Only extreme dilatation causes signs on frontal view
Straightening/ convexity of left upper cardiac contour
Upturned cardiac apex
Left upper cardiac margin parallels left main stem bronchus as a long convex curvature
Large appearance of MPA
Occurs higher on the left heart border between left ventricular contour and pulmonary outflow tract

36. LAT CXR
Prominent convexity of ant heart border >1/3 distance from anterior cardiophrenic sulcus to sternal angle
Increased size prominent in retrosternal area

37. Valvular heart disease
Mitral valve disease
Mitral stenosis
Radiological sign:
1.Lt atrial enlargement with normal cardiac size
2. Mitral valve calcification
3.Increase pulmonary venous pressure.
4.Pulmonary edema.

39. Mitral regurgitation
Lt atrial &Lt.ventricular enlargement (increase cardiac size with LT ventricular configuration..
Pulmonary edema
Increase pulmonary venous pressure.

40. Aortic valve disease Aortic stenosis: valve calcification
Poststenotic dilation in ascending aorta
LT ventricular enlargement
Pul. venous hypertension.
3&4 are late features

42. Aortic regurgitation Dilated ascending aorta.
Lt. ventricular enlargement (early)

43. Tricuspid valve Stenosis& regurgitation:
Enlargment of Rt.atruim & SVC.

45. Congenital heart disease:
Pulmonary stenosis
Normal cardiac size
Enlargement of main pul. A.
Coarctaion of aorta:
1.Indentaion on aortic arch.
2.Dilation above coarctation due to Lt.subclavian A. enlargement
3.Dilation below coarctation due to poststenotic dilation of aorta.
4. Cardiac enlargmnt
50. Rib indentation : in long standing cases small cortical rib indentation due to enlargements of intercostal vessels.

48. Tetralogy of fallot : VSD Overriding of aorta
Rt ventricular outflow obstruction
RV hypertrophy.
Radiological features:
Normal CXR 50%.
Boot shape heart
Oligaemic lung
Rt side aorta in 25%.

50. ASD, VSD, &PDA. Cardiac enlargement. Enlargement of Lt. main PA.
pulmonary plethora.

51. Cardiac tumor Lt atrial myxoma
Most common benign cardiac tumor .it may arise from intra-atrial septum or cardiac wal
Radiological features:
Best seen by cardiac MRI or echocradic study.
Most patient have normal CXR.
It may pedineculates floating within atrium to mitral valve causing MV dysfunction mimic MS or MR.

52. Pericardium pericardial effusion
Marked increase in cardiac diam. With no specific chamber enlargements.
Calcifications seen up o 50% of constrictive pericarditis.
By echo study :
As little as 25-50cc can be seen as echo-free fluid echogenisty between cardiac wall &pericarduim.

55. Pericarditis is defined as inflammation of the pericardium
Pericarditis is defined as inflammation of the pericardium. It is normally found in association with cardiac, thoracic or wider systemic pathology and it is unusual to manifest on its own.
It can be sub typed according to morphology.
Acute forms
serous pericarditis
suppurative (purulent) pericarditis
tuberculous (caseous) pericarditis :
fibrinous pericarditis 
haemorrhagic pericarditis
Established forms
constrictive pericarditis
adhesive pericarditis
Radiographic features
CT / Carciac CT 
At contrast-enhanced CT, enhancement of the thickened pericardium generally indicates inflammation 1.
Cardiac MRI
Usually T1, T2 and GRE cine sequences are performed.  
The normal pericardial thickness is considered 2 mm while a thickness of over 4 mm suggests a pericarditis  The presence of an arrthymia may induce artefacts.

57. Aortic aneurysm Normal aortic daim Ascending=5cm Arch=4cm
Descending=3cm
Abdominal =2cm

58. false aneurysm (or pseudoaneurysm) Causes congenital atherosclerosis
Aneurysms are focal abnormal dilatation of a blood vessel. They typically occur in arteries, venous aneurysms are rare. Aneurysms may also occur in the heart.
Pathology
Pathological types
true aneurysm
false aneurysm (or pseudoaneurysm)
Causes
congenital
atherosclerosis
hypertension
vasculitis
hereditary connective tissue disorders
Marfan syndrome
Ehlers-Danlos syndrome
fibromuscular dysplasia
infection: mycotic aneurysm, syphilis (luetic aneurysm)
trauma
iatrogenic
myocardial infarction: may cause left ventricular aneurysm
flow related (in cerebral AVM, contralateral ICA occlusion etc)
Morphology:
saccular aneurysm: eccentric, involving only a portion of the circumference of the vessel wall
fusiform aneurysm: concentric, involving full circumference of the vessel wall
Complications
rupture
distal thromboembolism
pressure effects

61. Thanks