Radiological examination of the heart and great vessels

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L’cardiac imaging brings together an arsenal of’examination’additional interest which looks like this :

Standard chest x-ray :

– Remains l’exam the 1time intention before a :
+ Physical examination
+ suspect electrical tracing ( ECG)
– quick and inexpensive examination.
– Often allows to draw a fairly reliable overall picture of the patient's health.

Echocardiography :

– Technique non invasive, available and inexpensive
– Review key heart disease.

Computed tomography and nuclear magnetic resonance :

Technological advances in machines and the current possibilities of l’cross-sectional imaging (CT : TDM multi- detectors and MRI), have contributed to the’non-invasive morphological and functional exploration of the heart.

cardiac scintigraphy :

– Diagnostic tool’isotopic exploration of the myocardium
– Necessary before the following risk factors : Diabetes, Smoking, Hypertension and dyslipidemia
– Asked immediately before abnormal electrical tracing(ECG) : complete left branch block

Technique :
– injection’a radioactive tracer : Thallium 201 or technetium
– Special sensor: Scintigraphe:
+ Records the distribution of the injected substance in the different parts of the’organ examined.
+ This distribution is displayed as a series of points "Glitter" corresponding to the areas marked by the active product.

heart catheterization :

Invasive method of’relatively old exploration (cardiac and vascular catheterization) is characterized by selective injections of iodinated contrast agent in the heart chambers and the coronary arteries.

Angiography Cardiac / Coronagraphy :

Technique’examination which rapidly improved knowledge of the structures and functioning of the normal and pathological heart through a hemodynamic and morphological study of the heart chambers and vessels.
– Catheterization of the’femoral artery : left heart or great vessels
– The femoral vein catheterization : right heart

TECHNICAL MEANS D’EXPLORATION :

1- INCIDENCES :

4 clichés: Face, profile, Oblique right anterior (BEANS) / Left anterior oblique

(OAG).

– Standing face shot : Posteroanterior (ray entering from the back, plate on the anterior chest), deep breath and high voltage (115-130kV).

Cliché profile : same conditions, only l’incidence changes becoming lateral (left part against the plate).

– Cliché and OAD : right part of the body placed against the plate making a 45 ° angle with the RX.

– Cliche in OAG : left side placed against the plate making a 45 ° angle with the RX RADIOGRAPH THORACIC +++++

2- TECHNICAL ACHIEVEMENT AND CONSTANT USED Chest :

– Exposure time : short shot and made Apnea

Distance fover-film : 2m for distance thorax Face

3- QUALITY LAYOUT :

Criteria for checking the quality of the thorax :

  • Distance between the inner edge of the collarbone thorny : equal to the right and left.
  • Epineuse of 3th thoracic vertebra centered (CXR, is Front)
  • Air-fluid level in the gastric pouch (patient standing)
  • diaphragmatic right : at or below the front of the sixth costal arch &) Butts bag costo-diaphragmatic : visible (shot made deep breath)
  • Spine and vessels visible behind the heart : aspect meaning that l’exposure is correct.

OBLIQUE IMPACT OR CROSS HEART :

RX TO SKEW RIGHT PRIOR (BEANS)
RX TO LEFT FORMER OBLIQUE (PAG) : – rarely indicated / – True heart profile can see all the aorta / – posterior margin / – front edge (YD overcome aortic)

ECHOCARDIOGRAPHY :

  • Technique’imagerie US, l’echocardiography or l’heart ultrasound or’cardiac doppler ultrasound, quickly found its place among the medical applications of ultrasound.
  • Non invasive, available, d’frequent indication (child, pregnant woman and duration lOmn 30mn )
  • morphological and functional information.

– Morphology and kinetics of heart valves
– Various features of the heart operation

IMAGING SECTIONAL :

CT MULTI-SENSORS HEART AND VASCULAR :

– Morphological and functional exploration of coronary and heart
– Requiring a course of’particular examination with good patient preparation.
– Acquisition synchronized on the’ECG
– Reconstruct the images in the different phases of the cycle.

CARDIAC MRI :

Reference method for’imaging of:
– Congenital heart disease, cardiac tumors
– Large vessels and pericardium

Thanks to :
– A good spatial and temporal resolution
– A Three-dimensional approach
– Excellent contrast between the circulating blood and the myocardium.

Determination parciné MRI :

standardized, Precise and Reproducible.
– ventricular volumes
– Fraction d’ejection
– myocardial mass
– kinetics segmental

MRI contrast after gadolinium injection : considerable diagnostic value for :
– many diseases:
– tumoral, inflammatory, ischemic
– Specify l’etiology of’cardiomyopathy.
– Reference method in the’myocardial viability analysis (ischemic heart disease)

Major advantage of the’IRM :

  • To be able to associate’myocardial viability study : l’perfusion analysis
  • Functional approach of heart muscle :

– Functions right and left ventricular resting
– During’provocative d’myocardial ischemia.

TECHNICAL PROTOCOL :

Different sequences are used to provide :
1- morphological assessment in:
-conventional anatomical planes
-Specific plans of the heart
2- Analysis of cardiac functional parameters :
– ventricular mass – Fraction d’ejection – Volume d’ejection
– Thickness infarction – Kinetics segmental and global &) Volumes ventricular end-diastolic and systolic TV
3- hemodynamically including sequences in phase contrast for quantization: Flow rates / speeds (pulmonary- systemic)
4- Analysis of the infusion 1is passing infarction
5- MRA with gadolinium
6- delayed enhancement (myocardial viability) +++++

SCINTIGRAPHY HEART :

myocardial scintigraphy : Further examination to assess the: heart function (perfusion, metabolism, cellular integrity…).

INTEREST :
Confirm or deny the coronary character of’chest pain by identifying the’myocardial perfusion state
Myocardial scintigraphy coupled to a: -Test d’effort and / or drug stimulation.

1- normal vasculature :

homogeneous fixing
Perfusion tracer uptake in the myocardium : normal
Normal test
Pain presented by the patient is not d’coronary origin

2- abnormal vascularization :

It is more or less extensive and is characterized by : tracer uptake defect on the myocardium
A 2th passing under the camera 3, 4, indeed 24 hours, to compare the initial images to images taken at rest.

CARDIAC CATHETERIZATION :

Introduce an X-ray opaque probe into the right cavities through the femoral vein and the left cavities through the’femoral artery.

INTEREST :

1- Measure intracardiac and intravascular pressure

2- Take blood samples

3- lnjecter various indicators to measure cardiac output and detect an intracardiac shunt

4- lnjecter the iodinated contrast agent for a morphological and functional study of cavities / vessels: – ANGIO-CARDIOGRAPHIE – CORONOGRAPHIE

INDICATION OF EACH MEANS D’EXPLORATION :

COUPLE : RX STANDARD + ECHOCARDIOGRAPHIE
Broad indications before or after electrical examination (ECG)
CT HEART

TWO TYPES OF’INDICATIONS :
– APPROPRIATE
– NOT APPROPRIATE

RELEVANT INDICATIONS :

– INDICATIONS CLASSIC:
– Pulmonary embolism / Aortic dissection
– Assessment of aneurysms’aorta
– ANATOMY REVIEW
– DIAGNOSTIC RESULTS OF CORONARY PATIENTS

INDICATIONS NOT APPROPRIATE :

  • acute chest pain and ECG modification with or increase in cardiac enzymes.
  • Patient at high risk or with a positive intermediate functional test.
  • asymptomatic patient, low risk after myocardial revascularization (bypass Surgery, Stent)
  • Characterization of the plaque
  • Measuring the aortic valve area
  • Realization of single calcium score in the symptomatic patient or proven coronary

SCINTIGRAPHY :

– Myocardial viability (detection of necrosis)
– cardiac shunts

CATHETERIZATION / angiography :

  • Acquired valvular heart disease
  • congenital
  • ischemic heart disease
  • Pulmonary arterial hypertension or heart failure
  • Post Heart Surgery
SEMIOTICS RX STANDARD

– Cut , Morphology of the cardiac silhouette
– Container and contents.

CHEST X-RAY PROFILE LEFT :

  • ovoid heart
  • front edge :

– upper arc (ascending aorta)
– lower arc (right ventricle : CEO)

  • top edge :

– 1/3 inferior (right ventricle : CEO)
– 2/3 superior (right ear : FROM)

SEMIOLOGY ABNORMAL :

1- DILATATION / CARDIAC HYPERTROPHY CAVITIES
2- BIG SHIPS
– Aortic Coarctation
– NEVRYSM OF L’AORTA
– DISSECTION OF L’AORTA

Dilation of l’right atrium :
Enlargement of the’lower right arch which appears more convex.
– Hyper-convexity and overhang of the’lower right arch (AID)
In case of :
– atresia triscupide
– CIA high flow

Dilatation of the right ventricle :
Train:

  • Protrusion of the’lower left arch with rounded appearance
  • Pointe raised.

Hypertrophic Dilation RV :
– Overhang’lower left arch with raised point (heart in hoof’extreme)
– Obstacle in the pulmonary route ( Narrowing of the valve or trunk of the’pulmonary artery)
– Heart in shoe : Tétratologie of Fallot : complex heart defect that combines between severe stenosis of the pulmonary route with important HVD

Dilation of l’pulmonary artery :
causes : abnormal protrusion of the’medium arc.

Dilation of l’aorta :
causes : protrusion of the’upper right arch

LAYOUT CHEST :

View pathological calcifications that may affect :
– heart valves -the pericardium
– the wall of the vessels in particular the’aorta

CONCLUSION :

The technical means intended for’exploration of the heart and large vessels are numerous but the choice depends on:
– studied pathology
– Patient Clinical Status
– electrical tracing
– Availability of devices’explorations.

– If the information is sufficient, preferably start l’exploration by d technique’least invasive or completely harmless imaging in this case’B-mode ultrasound and cardiovascular Doppler.

– Each technique brings one or more semiological signs which are specific to it and the’association of different types of’exam, is often complementary.

The standard cliché remains essential that the technical achievement must be respected ( quality criteria )

L’echocardiography exam 1time intention: morphological and functional

L’non-invasive cross-sectional imaging :
– Coronary CT =
– MYOCARDIAL VIABILITY MRI =

Dr Lecheheb's course – Faculty of Constantine