Cardiovascular Imaging: Lecture Notes

What makes up the cardiac silhouette?

1. heart
2. pericardium
3. pericardial fat
4. fluid

What is the abnormality?

Gas in the pericardial space

What makes up the cardiac silhouette?

1. heart
2. pericardium
3. pericardial fat
4. fluid

What is the abnormality?

Gas in the pericardial space

***How big should the heart big on lateral rads?

How much sternal contact?

Dogs: 2.5-3.5 ICS

Cats: 2-3 ICS

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Sternal contact: 2.5-3 ICS

On a lateral radiograph, what structures summate from 9-11 o’clock?

1. main pulmonary artery/pulmonary trunk
2. aorta
3. right auricle

Where is the left atrium located on a lateral projection?

At the carina

Can sometimes see a backpack sign

What is located at 1? At 2?

1 = right auricle, aorta, main pulmonary artery

2 = left atrium

How large should the heart be on VD/DV view?

2/3 the width of the thoracic cavity

***What is the DV/DV clock face analogy?

11-1 o’clock = aortic arch

1-2 o’clock = main pulmonary artery

2-3 o’clock = left auricle

3-6 o’clock = left ventricle

6-9 o’clock = right ventricle

9-11 o’clock = right atrium

***What is 1-7 on this image?

1: aortic arch

2 = main pulmonary artery

3 = left auricle

4 = left ventricle

5 = right ventricle

6 = right atrium

7 = left atrium

What are ddx for a globoid silhouette?

1. pericardial effusion
2. DCM
3. peritoneopericardial diaphragmatic hernia
4. tricuspid valve dysplasia

What is the shape of this heart? What are ddx?

Shape: globoid

1. pericardial effusion
2. DCM
3. peritoneopericardial diaphragmatic hernia
4. tricuspid valve dysplasia

What is the diagnosis here?

Peritoneal pericardial diaphragmatic hernia

-not great diaphragm margins

-has structure in cardiac silhouette

What is the heart shape?

Diagnosis?

Globoid

Pericardial effusion in this case

What are these examples of?

PPDH

What is the diagnosis?

How do we know?

PPDH

• region of increased ST opacity
• possible stones in bile duct of liver

What is a normal vertebral heart scale score?

9.7 +/- 0.5 vertebrae, starting at T4

What is the vertebral heart scale useful for?

Monitoring

***How to remember which are veins and which are arteries?

Veins: ventral and central

Arteries: up and away

What is 1 and 2 in this image?

1 = artery

2 = vein

***How big should pulmonary arteries and veins be?

Should be same size

• Lateral projection: cranial vessels
  • size of proximal 4th of 4th rib
• VD projection: caudal vessels
  • size of 9th rib where they overlap

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1.22 right caudal vein to 9th rib

(right caudal vein can be a little large than the 9th rib and still be normal)

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1. What type of hypertrophy does volume overload cause?
2. Does this cause apparent cardiac enlargement?
3. Example?

1. eccentric hypertrophy

   1. TIP: think eccentric person is outgoing, pushing out

2. apparent cardiac enlargement (large lumens)

3. shunting lesions

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1. What type of hypertrophy does pressure overload cause?
2. Does this cause apparent cardiac enlargement?
3. Example?

1. concentric hypertrophy
2. thickened muscles, small lumens, not really outwardly apparent enlargement
3. stenotic lesions

***What are the 4 most common congenital cardiac diseases in small animals? What is most common in large animals?

Small animals

1. aortic stenosis
2. pulmonic stenosis
3. patent ductus arteriosus
4. tricuspid valve dysplasia

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Large animals

1. ventricular septal defect

What are the radiographic findings?

Diagnosis?

• bulge of aorta
  • 11-1 o’clock on VD
  • can’t distinguish from aorta, pulmonary artery, or right auricle on lateral

Aortic stenosis

What are the radiographic findings?

Diagnosis?

• bulge of main pulmonary artery
  • 1-2 o’clock on DV/VD
  • can’t distinguish from aorta, pulmonary artery, or right auricle on lateral

What are the radiographic findings?

Diagnosis?

• aorta bulge, MPA bulge
  • three knuckle appearance (aorta bulge, main pulmonary artery bulge, left auricle bulge) - not seen here, but common in PDA dogs
• enlarged vessels

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PDA

What are the radiographic findings?

Diagnosis?

Globoid cardiac silhouette

• centered around right atrium (we don’t need to be that specific)

What are clinical signs/signalment of tricuspid valve dysplasia?

1. young dog
2. right sided murmur

***What are examples of acquired left-sided heart disease?

1. degenerative mitral valve disease (75% of cases)

2. DCM

   1. may also cause right-sided disease

3. hypertrophic cardiomyopathy (cats)

***What are examples of acquired right-sided heart disease?

1. heartworms

2. tricuspid valve disease

   1. can be acquired or congenital
   2. acquired: can have right-sided changes as well if MVD present

What are the radiographic findings?

Diagnosis?

Findings on lateral:

1. loss of caudal cardiac waist (flat line)
2. bulge of left atrium
3. dorsal deviation of trachea

Findings on DV/VD:

1. bulge at 2-3 o’clock = left auricle
2. enlarged left atrium (double wall sign)
3. a little right sided rounding

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Diagnosis: mitral valve degeneration

• probably some tricuspid valve degeneration as well b/c of right-sided rounding

What are the radiographic findings?

Diagnosis?

Findings:

• loss of cardiac waist
• rounding of right side
• left atrial enlargement

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Not definitive diagnosis until echo performed

• likely DCM

What are the radiographic findings in this cat on the left? (normal on right)

Diagnosis?

Findings:

• fat potato heart

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Likely HCM

***Ddx for enlarged hearts in cats?

1. HCM (most common)
2. restrictive CM
3. thyrotoxic CM
4. dilated
5. unclassified CM

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*Radiographs are not definitive for underlying cause for feline heart disease

*Echocardiogram needed to further investigate

What are the radiographic findings for the cat on the left? (normal on right)

Diagnosis?

Findings:

1. fat potato heart
2. left-sided enlargement

Diagnosis

1. HCM most likely

What are the radiographic findings?

Diagnosis?

Findings on VD:

• pulmonary artery enlargement
• bulge of MPA
• reverse D

Findings on lateral:

• possibly increased sternal contact (right ventricular enlargement)

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Diagnosis: HW disease

***What are radiographic signs of left-sided heart failure?

1. cardiogenic pulmonary edema'

   1. unstructured groundglass opacity, possibly consolidation

2. pulmonary venous congestion

3. left sided cardiac changes

   1. atrial/ventricular enlargement
   2. dorsal deviation of trachea

4. cats: can have pleural effusion

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*Diuretics can cause vessels to be normal or small

***What are radiographic signs of right-sided heart failure?

1. distended CVC

2. hepatomegaly

3. peritoneal effusion

4. pleural effusion

5. right sided cardiac changes

   1. rounding of atrioventricular region, possible bulge of main pulmonary artery depending on disease location

What are the radiographic findings in a cat?

Diagnosis?

Findings:

• more ventral distribution of increased opacity
• groundglass opacity

Diagnosis:

• CHF

What are the radiographic findings in a dog?

Diagnosis?

Findings:

• peri-hilar or caudodorsal ground-glass opacity

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Diagnosis: CHF

What start of MVD do we start using medical mangement?

Stage B2 (left atrial or ventricular enlargement on radiograph)