1、Section 1 The Heart1.Types of Heart in the Plain Films In the normal condition,a heart often appears in the horizontal（横型）,oblique（斜型）,and pendulous（悬垂型）type respectively on a posteroanterior radiograph of the heart.The angle of the cardiac axis（心轴角）:it is an acute angle formed by a line from the co
2、njunction of the great vessules of the right cardiac border and the right atrium（心房）to the cardiac apex（心尖）and a horizontal line which passes through the cardiac apex.心轴角：右心缘大血管与右房交界点至心尖的连线，与水平线的夹角。心轴角：右心缘大血管与右房交界点至心尖的连线，与水平线的夹角。The horizontal type（横型）45 (52 55)Three types of the heart in the plain
3、filmIn the pathological states,the heart can be deformed in the mitral（二尖瓣型）,aortic（主动脉型）,and general enlarged（普大型）type separately.A type of the heart can derive from several heart diseases.For example,The mitral type of the heart may originate from pulmonary heart diseases,rheumatic heart diseases,
4、congenital heart diseases of shunt from left to right.The aortic type of the heart may come from hypertensive heart diseases,rheumatic heart diseases(involing aortic valves),congenital heart diseases,cardiomyopathy.The general enlarged type of the heart may come from cardiomyopathy,pericardial effus
5、ion.2.Different routine projections of the cardiac atria and ventricles PA:posteroanterior radiograph（后前位）LL:left lateral radiograph（左侧位）RAO:right anterior oblique radiograph（右前斜位）LAO:left anterior oblique radiograph（左前斜位）PA:posteroanterior radiograph（后前位）（后前位）LL:left lateral radiograph（左侧位）（左侧位）RAO
6、:right anterior oblique radiograph（右前斜位）cardiac atria are distinguished from cardiac ventricles.Two cardiac atria locate in the posterior superior part of the heart and two cardiac ventricles overlap and settle down in the anterior inferior part of the heart.LAO:left anterior oblique radiograph（左前斜位
7、）the shadow of the heart is divided into two halves of the right heart and left one.The right one stays in the front and the left one rests on the back.3.The cardiothoracic ratio(心胸比率)Calculation of the cardiothoracic ratio has been the simplest and most frequently used method for measurement of the
8、 heart.The cardiothoracic ratio =(A+B)/CThe ratio is defined as the value of the transverse dimension of the heart divided by the innner dimension of the thoracic cavity at the level of crossing the dome of the right hemidiaphragm.Relation between size of the heart and thecardiothracic ratio:Normal
9、heart less than 0.52Slight enlargement 0.52 0.55Moderate enlargement 0.56 0.60Severe enlargement more than 0.604.Changes of pulmonary blood Pulmonary arterial pleonaemia(肺充血)：means that pulmonary arteries have been broadened in all its trunks and branches.Pulmonary venous pleonaemia(肺淤血)：refers to t
10、he situation that excessive blood stagnates in the pulmonary veins.So,the lung fields have an attenuated radiolucency and seem like ground glass.5.Pulmonary edema(肺水肿)In interstitial edema(间质性肺水肿)，both pulmonary hila exhibit enlargement and hazy shadows.The lung markings appear abundant with fuzzy m
11、argins.These blur the border of the heart associated with dilation of bilateral upper pulmonary veins.In alveolar edema(肺泡性肺水肿)，there are large patchy opacities surrounding the pulmonary hila in the shape of a butterfly.The shadows of the arches fade out in the heart.Cases in the HeartCase 1.正常心脏三位片
12、正常心脏三位片The thoracic cage remains symmetrical.All the seen bones are nothing remarkable.The trachea locates centrally without deviation.The lungs are clear,while the lung markings are natural and regular.Both pulmonary hila show neither enlargement nor decrease.The heart and great vessels appear norm
13、al in their position,size and shape.The cardiothoracic ratio is 0.48,and all the shadows of the arches show naturally in the margins of the heart.The diaphragm has a smooth surface with sharp costophrenic angles.On the LL radiograph,the spaces exist in the precardiac and retrocardiac clearances.Ther
14、e is no significant change in the shadows of the arches of the heart.On the RAO radiograph,all the shadows of the arches appear clear and nature in the heart.There is no compressive displacement in the esophagus.Nothing is remarkable in the precardiac and retrocardiac apaces.Diagnosis:Normal in the
15、lungs,heart,and diaphragm.Case 1.正常心脏三位片正常心脏三位片Case 2.风湿性心脏病风湿性心脏病The lung fields have an attenuated radiolucency.The lung markings exhibit thickenings and distortions with blurred edges and seem like ground glass.Both pulmonary hila are enlarged,and the diameter of the right inferior artery（右下肺动脉）t
16、otals 1.8 cm with the sign of residual root（残根征）.The heart appears in the mitral type（二尖瓣型）.The shadow of the heart extends on both sides in the cardiothroacic ratio of 0.65.There are 4 arches in the left margin（四弧征）,while dual bows（双房影）in the right margin of the heart.The angle is almost 90between
17、the two main bronchi.On the LL radiograph,the clearances are closed in both precardiac and retrocardiac spaces due to enlargement of the heart.The enlarged left atrium compresses the esophagus to form an indentation.On the RAO view,the precardiac and retrocardiac spaces are enclosed.The enlarged hea
18、rt pushes the esophagus backward,forming an arch indentation in the esophagus and overlaps with the spinal column.Meanwhile,the segment of the pulmonary artery bulges significantly.Diagnosis:Rheumatic heart disease.Further examination is needed by heart Doppler ultrasound.Case 2.风湿性心脏病风湿性心脏病Case 3.室
19、间隔缺损（VSD）The lung markings become enriched and thickened.Both pulmonary hila are enlarged.The cardiac shadow has moderate enlarged with the cardiothoracic ratio of 0.60.The aortic knob(主动脉结)is not enlarged.The segment of the pulmonary artery(肺动脉段)sinks and the cardiac apex becomes round and obtuse.O
20、n LL and RAO,the spaces have been decreased in both precardiac and retrocardiac clearances,associated with slight compressive displacement of the esophagus to the back.But the triangle clearance of the retrocardiac space still exists.Diagnosis:Ventricular septal defect is considered.Case 4.房间隔缺损(ASD
21、)The lung markings become enriched and thickened.Both pulmonary hila exhibit enlargement and the diameter reaches to 2.0 cm in the right inferior pulmonary artery.The shadow of the heart extends to both side in the mitral type(二尖瓣型).The cardiothoracic ratio reaches 0.59.The segment of the pulmonary
22、artery(肺动脉段)bulges but the aortic knob(主动脉结)shrinks.On the LL radiograph,the clearances decreases in both precardiac and retrocardiac spaces.But the triangle clearance of the retrocardiac space still exists.Diagnosis:Congenital heart disease with pulmonary polyhaemia.Atrial septal defect is consider
23、ed.Case 5.法洛四联症(tetralogy of Fallot)The lungs show hyperradiolucency with attenuated pulmonary blood vessels.Both pulmonary hila are decreased.There are areas of scattered dot-like and patchy inhomogenous opacities with hazy margins in the right upper field.The shadow of the heart looks in the aorti
24、c type(主动脉型)with the cardiothoracic ratio of 0.64.The aortic arch(主动脉弓)is broadened.The cardiac waist（心腰）shows a depression.The apex of the heart appears round and upturned.On the left lateral rasiograph,the anterior margin of the heart bulges obviously,but the segment of the pulmonary artery sinks.
25、The posterior margin of the heart extends to the back and occupies a part of the retrocardiac space.Diagnosis:1.A congenital heart disease with oligemic pulmonary blood volume is considered,and most probably,tetralogy of Fallot.Further examination is necessary,such as Doppler or MRI.2.Pneumonia is c
26、onsidered in the right upper field.Reexamination is suggested after treatment.Case 5.法洛四联症(tetralogy of Fallot)Section 2 The Pericardium(心包)心包壁层心包壁层心包脏层心包脏层心心 房房心心 室室心包积液心包积液1、The normal state There is almost 50 ml of transparent yellowish serous fluid in the pericardiac space.The thickness ranges 1
27、.0 2.0 mm in the parietal pericardium,which can not be seen in X-ray radiographs.2、X-ray findingsWhen pericardial effusion is less than 300 ml，it is difficult to find with X-ray examination because the fluid remains in the recess of the pericardium.If it is over 300 ml,the shadow of the pericardium
28、shows enlargement and extends to both sides on condition of no pericardial adhesion.The normal arches of the heart will fade out in this instance.In acute pericardial effusion,the accumulation of fuild may reach 10002000 ml.Then,the shadow of the heart looks like a flask.Otherwise,it seems to be a b
29、all in chronic pericardial effusion.Cases in the PericardiumThere is nothing abnormal in both pulmonary hila,the lung fields and bilateral hemidiaphragms.The shadow of the heart extends obviously to both sides like a flask with the cardiotharacic ratio of 0.74.The arches of the heart disappear in th
30、e margins.The shadow of the aortic arch becomes shortened.On the LL view,the shadow of the heart has been enlarged in the antero-posterior diameter,which causes disappearance of the precardiac and retrocardiac spaces.Diagnosis:Pericardial effusion in a large volume.Thank You世界触手可及世界触手可及携手共进，齐创精品工程携手共进，齐创精品工程
