Diagnostic Radiology of Cardiovascular SystemChen, ShaoqiongAcknowledgement : most of the slices are refer to the ppt provided by Dr. Biling Liang is gratefully acknowledged.2/231Diagnostic Radiology of Cardiovascular SystemImaging methodsnormal appearancesabnormitiesdiseasesmethodsnormalabnormitiesdiseasesCadiovascular Anatomy heart多层螺旋心脏大血管CTA （三维重建图）多层螺旋心脏大血管CTA （三维重建图）MethodsnX-ray nFluoroscopy nPlain radiography ?nAngiocardiography & DSAnCT & CTAnMRI & MRAnEchocardiography (US)nNuclear medicine8/231X-ray- PA view-high KV, 2MX-raymethodsnormalabnormitiesdiseases9/231X-ray- Lat viewX-raymethodsnormalabnormitiesdiseasesleft lateralObserving the chest plain filmnThe size, shape, and position of the heartnThe state of the lungs and pulmonary vesselsnAorta and cardiac calcificationsmethodsnormalabnormitiesdiseases11/231Normal appearancenright ventricle, atrium : frontnleft ventricle, atrium : behindmethodsnormalabnormitiesdiseasesLocation of the heart： 2 / 3 on the left side of midline，1/ 3 on the right side apex of heart point to left bottom，oblique axis12/231Normal appearance -PA ViewnComposition：nRight border of heart：naorta（old）、superior vena cava（youth）nright atriumnLeft border of heart ：naortic bulb：aortic archnpulmonary artery segment（ cardiac waist）：main pulmonary arterynleft ventricle：methodsnormalabnormitiesdiseasesUpper 1/2Lower 1/2midline7020p Aorta arch below the clavicle, 2.01.0cmp aorta arch wider and higher eldly, high BPp no aorta knob - right aorta arch variationp aorticopulmonary window small indentation of the lung into the mediastinum, between the arch and left PA14/231PA viewmethodsnormalabnormitiesdiseasesLeft atriumPVPA15/231Normal appearance - Lat. viewnComposition:nAnterior border of heart nAscending aorta nThe infundibular of the right ventricle, pulmonary trunknAnterior border of right ventriclenPosterior border of heartnLeft atriumnLeft ventriclemethodsnormalabnormitiesdiseasesThe normal R. atrium is not border-forming in this projection16/231Normal appearance- Lat. viewmethodsnormalabnormitiesdiseasesRetrocardiacesophageal spaceRetrosternal spacethe anterior heart border touch the1/3 of the distance between the diaphagm and the suprasternal notch RVRVCTCTX-ray17/231Normal appearance - Lat. viewmethodsnormalabnormitiesdiseasesp normal L. atrium dont displace the esophagusBarium-filled esophagus18/231Size of the heart and great vesselsmethodsnormalabnormitiesdiseasesNormal：C / T 0.5 Slightly enlarged：0.51- 0.55 Moderately enlarged：0.56- 0.60 Massively enlarged：0.6019/231Size of the heart and great vesselsmethodsnormalabnormitiesdiseasesabC/T ratio = a+b / T= 0.5T20/231Influencing factor of the normal heart shadownBody type：oblique , transverse , verticalnAge ：with age grows，globularobliquehorizontal nRespiration：ninspiration：dropping heart, normal heart shadownexpiration：heart shadow horizontalnPatient position：nerect position：heart shadow elongatednlying position：heart shadow enlargementmethodsnormalabnormitiesdiseases21/231Influencing factor of normal heart shadow - body typenhorizontal heartnoblique heartndropping heartclassification： horizontal heart oblique heart dropping heartC/T R 0.5 0.5 1/3 (narrow of the retrosternal space)nCommon disease：nMitral valve stenosisnChronic pulmonary heart diseasenPulmonary stenosisnPulmonary hypertensionnFallots tetralogynASD , VSDmethodsnormalabnormitiesdiseases36/231Right ventricular enlargementmethodsnormalabnormitiesdiseases37/231Left atrium enlargementnX-ray ：enlarged LA bulges to back & rightnPA right border：double density of left atrial enlargement nPA left border：Indentation where the left atrium, when it enlarges, will appear on the left side of the heart nLat & RAO：middle of esophagus compressed and displaced posteriorlynLAO：Elevation of left mainstem bronchus Common disease：nmitral lesionnleft ventricular failurencongenital heart diseases：nPDAnVSDmethodsnormalabnormitiesdiseases38/231Left atrium enlargementmethodsnormalabnormitiesdiseases39/231Right atrium enlargementnX-ray appearance：nPA：inferior segment of right border of heart extending to right , bulge, high bulge pointnLAO：the right atrial curvature at least half as long as the anterior border of heart， bulgenCommon disease：nright heart failurenASDntricuspid diseasenpulmonary vein ectopy drainagenatrial myxomamethodsnormalabnormitiesdiseases40/231Right atrium enlargementmethodsnormalabnormitiesdiseases41/231General cardiac enlargementnX-ray appearance：nPA：The cardiac shadow is increased to both sides, the transverse diameter increasednLat and RAO ：narrowing of both retrosternal space and retrocardiac space, the oesophagus is displaced backwardnLAO：the trachea bifurcation is sprayed, the trachea is displaced backwardnCommon disease：nPericardial effusionnMyocarditis nTotal cardiac failurenTotal cardiac fa