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Chest X Ray : Heart Failure Dr.Juan A.Venter Dept.Imaging Sciences Universitas Hospital

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Causes:PVH/Pulmonary Oedema Left Ventricular Failiure Left Ventricular Outflow Obstruction Mitral Valve Disease Left Atrial Myxoma Fibrosing Mediastinitis Pulmonary Venous Occlusive Disease

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Non Cardiogenic Pulmonary Oedema Normal Cardiothoracic Index Aspiration,Near Drowning ARDS Hepatorenal Failiure Post thoracocenthesis Rapid Lung Expansion Drugs : Aspirin,Nutrofurantoin,Opiates,Cytokines PS:Early post MI phase acute decrease in miocardial compliance

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Right Atrial Enlargement PA CXR: Prominent round superior border with SVC > 5,5 cm from midline to most lateral RA margin > 2,5 cm from right vertebral margin

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Right Ventricular enlargement PA CXR: Upturned cadiac apex Lateral CXR: > 1/3 contact distance from cadiophrenic sulcus to sternal angle

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Left Atrial Enlargement PA CXR: Retrocardiac double density >75 % splaying of carina with horizontal orientation of left mainstem bronchus Enlarged left convex left atrial appendage > 7 cm from LMB to right LA border. Lateral CXR: Posterior displacement of Ba filled oesophagus

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Left Ventricle Enlargement PA CXR: Downturned cardiac apex with leftward displacement Left diaphragmatic inversion Lateral CXR: Posterior cardiac margin > 1,8 cm posterior to IVC meassured 2 cm above intersection of right hemidiaphragm with IVC.(Hofman-Rigler rule)

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Cardiac vs Non Cardiac Oedema SignsCardiacRenal /Fluid Overload ARDS CARDIOMEGALY(uremic pericarditis) VASCULAR REDISTRIBUTIONBalanced WIDENED VASCULAR PEDICLE KERLEY LINES PERIBRONCHIAL CUFFING AIRSPACE OPACIFICATIONBasalCentralDiffuse PLEURAL EFFUSIONSVery Common Common

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Congestive Cardiac Failiure

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Stage 1 PCWP 13-18 mmHg Stage 2 PCWP 18 25 mmHg Stage 3 PCWP > 25 mmHg Redistribution Interstitial Oedema Alveolar Oedema Stages of CCF

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Redistribution/Cephalization

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Redistribution

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Interstitial Oedema

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Alveolar Oedema

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Gravity dependent density differences

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Cardiothoracic Index

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Pleural Effusion

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Vascular Pedicle Width: 85mm, 5mm = 1l

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VPW Serial CXR

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Azygos Vein Width : Erect > 10 mm, Supine > 15 mm, Serial X Rays > 3mm,Not depending on in - or expiration

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Right Ventricular Failiure

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References 1.www.radiology assistant.nl accessed 27/02/2012 2.Primer of Diagnostic Imaging Fourth Edition 3.Radiology Review Manual 6 th Edition