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Chen, ShaoqiongAcknowledgement : most of the slices are refer to the ppt provided by Dr. Biling Liang is gratefullyacknowledgedBasic X -ray featuresPericardial abnormal findingsabnormitiesdiseasesChanges of pericardium Normal pericardiumnormal abnormitiesdiseasesChanges of pericardiumnormal abnormitiesdiseasescardiac tamponade occursBasic X -ray features Changes of pericardium Pericardial anomalies methods normal abnormitiesdiseasesPericardial effusion X-ray appearance ：“water-bottle”or “flask”shape, globularmethods normal abnormities diseases Tuberculosis rheumatism uraemiavirus neoplasmFluid:TransudationexudationbloodPericardial effusionPericardial effusion on both lateralchest radiograph and axial CT.Red arrow points to fat outside ofpericardium. Green arrow pointsto pericardial space which is 8 mmin this patient (<4 mm isnormal.)The yellowarrow points to fat outside of heartand the blue arrow to themyocardium.Pericardial effusionPericardial effusion methods normal abnormities diseasesPericardial effusion normal abnormitiesdiseasesPericardial effusionerect positionsupine position normal abnormitiesdiseasesPericardial thickening 、calcification thickening ：Hemodynamic change:normal abnormitiesdiseasesConstrictive pericarditis X-ray ：Pericardial calcification ：normal abnormitiesdiseasesConstrictivepericarditis normal abnormitiesdiseasesPericardial calcificationConstrictive pericarditis-RA enlargementConstrictive pericarditis-RA enlargement-RA enlargementDiagnostic Radiology of Cardiovascular System Imaging methods normal appearances abnormities diseases methods normal abnormitiesdiseasesCommon diseaseof heart and great vesselsRheumatic heart diseasemethod normal abnormities diseasesRheumatic heart diseaseInvolved valve ：Mitral valve 、valvePathology ：stenosis Mitral valve insufficiencymethods normal abnormities diseasesMitral Stenosis Rheumatic Valvular Heart Disease ●Rheumatic heart disease causes mitral stenosis in 99.8% of casesRightVentricular HypertrophyStenotic mitral valve©Frank Netter, MD Novartis®•Mitral stenosis occurs •Left atrial pressure ↑•Left atrium enlarges •Cephalization •PIE•PAH develops •PVR increases •RV enlarges•Pulmonic regurg develops •Tricuspid annulus dilates •Tricuspid insufficiency •RV failureTime course of MS in adult©Frank Netter, MD Novartis®Effect of Mitral StenosisOn Lungs●↑Pulmonary venous and capillary pressureNormal5-10 mm HgCephalization10-15 mmKerley B Lines15-20 Pulmonary Interstitial Edema20-25Pulmonary Alveolar Edema> 25Mitral stenosishemodynamicsMitral valve stenosisLeft atrial output obstructedLV engorge insufficiently LA pressure increase & dilatePulmonary venous hypertension, interstitial pulmonary edema RV burden increase & enlargeaortic knob shrinkLV and aortic knob shrinkmethodsnormal abnormities diseasesMitral stenosisX-ray appearance ：Cardiac type ：“mitral LA & RV enlarged-------pulmonary artery segment Convexity LV shrink, Straightening of left heart border -------Aortic knob shrinkvalvular calcificationPulmonary venous hypertension, interstitial pulmonary edemanormal abnormities diseasesLA enlargementPA –right border ：Double density of left atrialenlargement ,double PA –left border ：left atrial appendageenlargementLat & RAO ：esophagus compressed Elevation of left mainstem bronchusRV enlargementpulmonary artery segment ConvexityLat ：contact between the front surface of heartand the sternum (anterior chest wall) >1/3Mitralstenosisnormal abnormities diseasesLA enlargementPA –right border ：double densityPA –left border ：left atrial appendage enlargement Lat & RAO ：esophagus compressedMitralstenosisLALVMitralstenosisMitralstenosisMitral stenosisLA,RV enlarge, Hemosiderin normalabnormitiesdiseases RV enlargementpulmonary artery segment ConvexityLat ：contact between the front surface of heart and the sternum(anterior chest wall) >1/3MitralstenosisnormalabnormitiesdiseasesMitralstenosisnormal abnormities diseasesLA enlargementPA –right border ：double densityPA –left border ：leftatrial appendageenlargementLat & RAO ：esophaguscompressedMitral stenosis normal abnormities diseasesPV hypertensionenlarged MPA CephalizationMitral stenosis ---Hemosiderindeposited methods normal abnormitiesdiseasesMitral stenosis —pulmonary interstitial edema --Kerley ’s B -line methods normal abnormitiesdiseasesCommon disease of heart and great vessels Ischemic heart diseasemethod normal abnormitiesdiseasesCoronary artery CTANormal Coronary artery CTA前降支和旋支前降支和对角支前降支和旋支心底部冠脉供血正常冠状动脉Ischemic heart disease normal abnormitiesdiseasesLV enlargementPA –cardiac apex extending to left and downleft ventricle segment extended,rounded,expandto leftLat ：retrocardiac space become narrowed ordisappeared, esophageal space disappeaered Aorta enlargedIschemic heart disease normal abnormitiesdiseasesmethods normal abnormitiesdiseasesCoronary artery CTACoronary artery calcification & soft plaque。
