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Radiology
Congenital and Pediatric Heart Disease
Built from Fundamentals of Diagnostic Radiology
What’s inside
9 sections · 80 slides
Overview
- Imaging the child with heart disease
- Framework for the chest x-ray
Pulmonary Vascularity
Classify the lung fields first: increased, decreased, or normal flow.
- Four vascularity patterns to classify first
- Classifying pulmonary vascularity
- Pulmonary vascularity patterns
- Pulmonary vascular patterns
- Pulmonary vascular patterns (continued)
- Active congestion: too much lung blood flow
- Active congestion
- Passive congestion: high pulmonary venous pressure
- Passive congestion
- Decreased vascularity
- Normal and asymmetric flow
Cardiac and Mediastinal Contours
The trachea, aortic knob, pulmonary artery segment, and heart give the clues.
- “
- Trachea and aortic arch
- Three left mediastinal contours
- Chest x-ray in a typical 3-year-old
- Heart size in children
- Pericardial effusion
- Pericardial effusion on x-ray and ultrasound
Acyanotic Heart Disease With Increased Pulmonary Vascularity
Left-to-right shunts: ventricular septal defect, atrial septal defect, patent ductus.
- Left-to-right shunts at a glance
- How a large shunt progresses
- Ventricular septal defect (VSD)
- Why a VSD shows up late
- Ventricular septal defect
- Atrial septal defect (ASD)
- Atrial septal defect
- Patent ductus arteriosus (PDA)
- Patent ductus arteriosus
- Ductal dependence and rare shunts
Cyanotic Heart Disease With Increased Pulmonary Vascularity
Admixture lesions mix oxygenated and deoxygenated blood.
- Cyanosis + increased flow = admixture
- D-transposition of the great arteries
- Two separate circuits in D-transposition
- The egg-on-a-string x-ray
- D-transposition of the great arteries
- Corrected (L-) transposition
- L-transposition (corrected transposition)
- Double-outlet right ventricle
- Double-outlet right ventricle
- Total anomalous pulmonary venous return (TAPVR)
- Obstructed TAPVR is an emergency
- Total anomalous pulmonary venous return, type 1 (snowman)
- Total anomalous pulmonary venous return with obstruction
- Cor triatriatum
- Cor triatriatum
- Truncus arteriosus
- Persistent truncus arteriosus
Decreased Pulmonary Vascularity
Right-sided obstruction plus a right-to-left shunt.
- Right-sided obstruction with right-to-left shunt
- Tetralogy of Fallot (TOF)
- The boot-shaped heart
- Tetralogy of Fallot
- Decreased vascularity in tetralogy of Fallot
- Repair and the most severe form
- Tricuspid atresia
- Tricuspid atresia
- Staged palliation for single-ventricle flow
- Staged palliation for single-ventricle flow
- Ebstein anomaly
- Ebstein anomaly
Normal Pulmonary Vascularity
When flow looks normal, the contours do the work.
- Normal flow, look at contours
- Pulmonic valvar stenosis
- Pulmonary artery enlargement in pulmonic stenosis
- Aortic valvar stenosis
- Aortic valve stenosis
- Coarctation of the aorta
- Two types of coarctation
- Coarctation of the aorta
- Coarctation with rib notching
- Hypoplastic left heart syndrome
- Hypoplastic left heart syndrome
- Norwood palliation
Cardiac Malpositions
Situs, cardiac position, and heterotaxy.
- Situs: how the organs are arranged
- Situs: normal, mirrored, or mixed
- Naming heart position
- Heterotaxy clues on x-ray
Summary
Get the vascularity right and call the cardiologist.
- What to take away
- References
- References (continued)
- References (continued)
- Brant and Helms' Fundamentals of Diagnostic Radiology