Cardiac Interpretation of Pediatric

Chest X-Ray

Try Arie Ichwanie (30101206732)

Saffana Okka Yuliani (30101206796)

Advisor :
dr. Lilis Utari , Sp. Rad
 Introduction
Chest X-ray

important tool in evaluating heart

disease
Easy to perform
Economical
Provides important
Many information
advantages heart size
pulmonary blood flow,
any associated lung
disease
 Approach to Chest X-Ray
Interpretation
Appears silhouette of overlapping
cardiovascular chambers and vessels.
Interpretation of chest X-ray systematically
considering : Heart size, Heart shape,
Pulmonary blood flow, Pleural space.
 Congenital Heart Disease
Cyanotic Congenital
Shunt Lession Obstructive Lession
Heart Lession
ASD Aortic stenosis TOF
VSD Pulmonary TA
PDA stenosis PA-IVS
AV Canal Defect Coarctation of the TAPVN
aorta TGA
RUANG JANTUNG
Retro Sternal-Cardiac Space
 Normal CXR
Right heart
AP View border

cardiac silhouette
occupies 5055%
of the chest width
Left heart border

CTR> 55%
Cardiomegaly
Pulmonary blood
flow pattern is
present with no
evidence of
pleural disease
Ao aorta, LA left atrium, LV left ventricle, PA pulmonary artery, RA right
atrium, RV right ventricle, SVC superior vena cava
Retro Sternal-Cardiac Space
 Shunt Lesions
Atrial Septal Defect
AP View
Shunting left to right across the defect increase in
pulmonary fullness of the right atrium enlarged
cardiac silhouette.
Lateral View
Right ventricle dilatation Obliteration of the usual
space between the heart and sternum.
ASD
 right atrial
enlargement
 Shunt Lesions
Ventricular Septal Defect
AP View
Shunting left to right cause an increase in pulmonary
blood flow engorged pulmonary vasculature , left
atrial and left ventricular dilation
Lateral View
Deviated esophagus
VSD
prominent
pulmonary
vasculature
 Shunt Lesions
Patent Ductus Arteriosus
AP View
Shunting left to right dilation of the pulmonary
vasculature left atrium and ventricle become dilated
Lateral View
Deviated esophagus
PDA
dilated main and
branch
pulmonary
arteries
 Shunt Lesions
Atrioventricular Canal Defect
AP View
Common with large atrial and ventricular septal defects
prominent pulmonary vasculature dilation of all
cardiac chambers
Lateral View
Left atrial dilation may cause posterior deviation of the
esophagus
AV Canal Defect
 enlarged due to
dilation of all
cardiac chambers
 Obstructive Lesions
Pulmonal Stenosis
AP View
Narrowed pulmonary valve orifice the main pulmonary
artery to dilate prominence of the pulmonary artery of
the cardiac silhouette, right ventricular dilation and
hypertrophy.
Lateral View
fullness of the upper retrosternal portion of the cardiac
silhouette, lower retrosternal portion of the cardiac
silhouette.
PS
main pulmonary
artery is dilated

left ventricular
apex is uplifted
 Obstructive Lesions
Aortic Stenosis
AP View
Narrowed aortic valve orifice ascending aorta to dilate
prominence of the aortic knob left ventricular failure and
dilation downward and lateral displacement of the
cardiac apex
Lateral View
Typically normal except in cases of congestive heart failure
AORTA STENOSIS
The aortic arc is
prominent

down and
outward
displacement of
the
cardiac apex
 Obstructive Lesions
Coarctation of the Aorta
AP View
Reverse 3 sign
Lateral View
Cardiomegaly
KOARTASIO AORTA
reverse 3 sign

left ventricular
failure and
dilation
Cyanotic Congenital Heart Lesions
Tetralogy of Fallot
AP View
Small or hypoplastic pulmonary arteries mediastinum to
appear narrow uplifting of the cardiac apex coeur en
sabot (boot shaped) appearance
Lateral View
Right ventricular hypertrophy will cause fullness of the
cardiac silhouette in the retrosternal region and anemic
lung appearance
TOF
coeur en sabot

left ventricular
apex is displaced
laterally and
upward due to
right ventricular
hypertrophy
Cyanotic Congenital Heart Lesions
Tricuspid Atresia
AP View
The right ventricle will be hypoplastic, rendering the
heart size small due to TrA must have a patent ductus
arteriosus (PDA) or systemic-to-pulmonary arterial
collaterals prominent pulmonary vasculature
Lateral View
This view may be within normal limits
Cyanotic Congenital Heart Lesions
Pulmonary Atresia-Intact Ventricular Septum
AP View
severe tricuspid regurgitation develop dilation of the right
atrium and ventricle Large shunts will cause an increase in
pulmonary blood flow manifesting as prominent pulmonary
vasculature
Lateral View
Cardiomegaly due to right atrial and ventricular enlargement
and prominent pulmonary vasculature is noted
PA-IVS
anemic
lungs the abscence of
pulmonary artery
segment due to
hypoplasia of the
main pulmonary
artery
Cyanotic Congenital Heart Lesions
Truncus Arteriosus
AP View
A single great vessel (truncus) resulting in a narrow
mediastinum, many patients with TA have DiGeorge
syndrome, where there is small or no thymus gland
Lateral View
The thymus gland is seen as soft tissue in the high
retrosternal region of lateral chest X-ray
TRUNCUS ARTERIOSUS
 narrowed
mediastinum and
cardiomegaly due
to biventricular
enlargement
Cyanotic Congenital Heart Lesions
Total Anomalous Pulmonary Venous Return
AP View
The dilated vertical vein, innominate vein, and superior
vena cava snowman appearance
Lateral View
This view may demonstrate the congested pulmonary
vasculature.
TAPVR
snowman
appearance
SNOWMAN APP..
Cyanotic Congenital Heart Lesions
Transposition of the Great Arteries
AP View
The oval/egg-shaped cardiac silhouette combined with
the front-to-back orientation of the aorta and
pulmonary artery narrowed mediastinum egg on
a string appearance
Lateral View
This may show an increase in pulmonary vascularity.
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