The inter-arterial course of the left coronary artery, also known as the malignant course of the left coronary artery, is defined as the origin of the left main or left anterior descending coronary artery from the right coronary sinus of Valsalva with a course between the ascending aorta and the...
Inter-arterial course of the right coronary artery (RCA), also known as a malignant variant, may occur if the right coronary artery has an aberrant origin from the the left coronary sinus. It is an uncommon anomaly with potential risk of cardiac ischaemia.
When the right coronary artery arises ...
Interatrial septal aneurysm or atrial septal aneurysm (ASA) is defined as an abnormal protrusion of the interatrial septum. The exact length of the protrusion that defines an interatrial septal aneurysm varies in the literature, ranging from >11 mm to >15 mm beyond normal excursion in adults 4-5...
Interventricular septal aneurysm is different from ventricular aneurysm which usually occurs in the cardiac apex. It is defined as a bowing of the interventricular septum of more than 15 mm on either side in adults and 5 mm in children during normal cardiac motion. It may involve either the memb...
Intra-aortic balloon pumps (IABP) are used in the intensive care setting to provide haemodynamic assistance to patients in cardiogenic shock.
Function and physiology
The device is comprised of a catheter introduced via the femoral artery, which extends retrogradely to the proximal descending t...
Intra-atrial course of the right coronary artery is an uncommon anatomic variation in the course of the right coronal artery, usually involving the mid and distal segments, where the vessel partially or completely courses through the right atrial chamber.
It is usually asymptomatic and clinical...
Intracardiac thrombi are seen in a variety of clinical settings and can result in severe morbidity or even death from embolic events. They can occur following myocardial infarction with ventricular thrombus formation, or with atrial fibrillation and mitral stenosis where atrial thrombi predomina...
Intraventricular is a term used to denote lesions / processes that occur within either the ventricles of the brain or the ventricles of the heart.
In both cases, most lesions actually arise from the surrounding brain parenchyma / heart muscle and grow exophytically into the ventricles.
Isomerism is a term which in general means 'mirror-image'. It is used in the context of heterotaxy and is of two types:
Mirror image of the structures on the left side of the chest along the left-right axis of the body, i.e. patients with isomeri...
Jaffe-Campanacci syndrome is characterised by:
multiple non-ossifying fibromas of the long bones and jaw
café au lait spots
hypogonadism or cryptorchidism
giant cell granuloma of the jaw
Kawasaki disease (KD) is a small to medium vessel vasculitis predominantly affecting young children. It can affect any body organ but there is a predilection for the coronary vessels.
An autoimmune aetiology has been postulated. It is generally self limiting but acute fatalities are ...
Kawashima procedure is a palliative surgical procedure performed in cases of:
left isomerism and azygos continuation of the inferior vena cava
single functional ventricle
single atrium and common atrioventricular valve with or without regurgitation
It is performed by crea...
Kommerell diverticula occur in some anomalies of the aortic arch system. It usually refers to the bulbous configuration of the origin of an aberrant left subclavian artery in the setting of a right-sided aortic arch. However, it was originally described as a diverticular outpouching at the origi...
One of the anatomical variants of coronary artery origin comprises the left circumflex coronary artery (LCx) and left anterior descending coronary artery (LAD) arising separately from the left coronary sinus. Hence there is no common left main coronary artery (LCA/LMCA).
As there is no vascular...
The left anterior descending (LAD) artery, also known as the anterior interventricular branch, is a branch of the left coronary artery.
It can be divided into proximal, mid and distal segments and this helps to differentiate the names of its various small branches 1:
The left atrial appendage (LAA) is a pouch-like projection from the main body of the left atrium lies in the atrioventricular sulcus in close proximity to the left circumflex artery, the left phrenic nerve, and the left pulmonary veins.
Four main morphologica...
Left atrial appendage (LAA) closure devices refers to a device placed in the LAA in patients with atrial fibrillation who cannot be anticoagulated pharmaceutically to prevent thromboembolic events. It is placed percutaneously via the femoral vein to right atrium to left atrium by forming a punct...
A left atrial diverticulum (LAD) refers to a pouch-like structure with a saclike shape with a broad-based ostium and a smooth contour to its body. They are considered an anatomical variant.
some suggest that there may be a possible latent relationship between LA diverticulum and...
Left atrial enlargement may result from many conditions, either congenital or acquired. It has some characteristic findings on a frontal chest radiograph. CT or MRI may also be used for diagnosis.
Broadly speaking, the causes of left atrial enlargement can be divided into congenital ...
The left atrial (LA) line monitors LA pressure and is indicative of left ventricular function, preload and afterload. The LA line enters from the left superior vein and exits the far side of the chest.
The LA line is a single lumen catheter unlike the right atrial line, which is double lumen. N...
The left atrium is one of the four chambers of the heart. It receives oxygenated blood from the pulmonary circulation that is then delivered to the left ventricle and then into the systemic circulation.
The left atrium is grossly cuboidal, and like the right atrium has an appenda...
The left main coronary artery (LMCA) or left coronary artery (LCA) is one of the two main arteries that supply the heart with oxygenated blood.
It is a branch of the ascending aorta, with its normal origin in the left aortic sinus, just superior to the aortic valve 1-2.
The left pulmonary venous recess is one of the pericardial recesses forming a small space within the pericardium. It arises from the pericardial cavity proper located between the right superior and inferior pulmonary veins, posterior to the left atrium. It invaginates towards the oblique pericar...
The left pulmonic recess is one of the pericardial recesses forming a small space within the pericardium, which arises from the transverse pericardial sinus. It is located posterior to the pulmonary trunk and left pulmonary artery.
It may mimic mediastinal lymphadenopathy or a bronchogenic cyst.
The left ventricle is one of four heart chambers. It receives oxygenated blood from the left atrium and pumps it into the systemic circulation via the aorta.
The left ventricle is conical in shape with an anteroinferiorly projecting apex and is longer with thicker walls than the ...
Left ventricular aneurysms are discrete, dyskinetic areas of the left ventricular (LV) wall with a broad neck (as opposed to left ventricular pseudoaneurysms), thus often termed true aneurysms.
True LV aneurysms develop in less than 5% of all patients with ST-elevation myocardial ...
Left ventricular assist devices (LVAD) are surgically implanted devices that aid pumping blood in patients with severe refractory cardiac failure. It may be used as a bridge to cardiac transplantation, or as destination therapy in patients who are not a transplant candidate.
The LVAD acts as a ...
A true diverticulum of the left ventricle refers to congenital anomaly affecting the left ventricle.
The condition typically occurs in children and if thought to occur in around 0.4% of cases based on autopsy studies.
In isolated cases, they are often asymp...
Left ventricular enlargement can be the result of a number of condition, including:
left ventricular aneurysm
The left ventricular outflow tract (LVOT) view (or five chamber view) is one of the standard views in a fetal echocardiogram.
It is a long axis view of the heart, highlighting the path from the left ventricle into the ascending aorta (left ventricle outflow tract).
In this view the right ventr...
Left ventricular pseudoaneurysms are false aneurysms that result from contained myocardial rupture, and are a rare complication of a myocardial infarction (MI). They should not be confused with left ventricular aneurysms, which are true aneurysms containing all the layers (endocardium, myocardiu...
A left-sided superior vena cava (SVC) is the most common congenital venous anomaly in the chest, and in a minority of cases can result in a right-to-left shunt 3-4.
A left-sided SVC is seen in 0.3-0.5% of the normal population and in ~5% of those with congenital heart disease 3. I...
Lipomatous hypertrophy of the interatrial septum (LHIS) is a relatively uncommon disorder of the heart characterised by benign fatty infiltration of the interatrial septum. It is commonly found in elderly and obese patients as an asymptomatic incidentally discovered finding.
Lipomatous metaplasia of the myocardium is a phenomenon where there is fat deposition within the myocardium. It is often seen following a myocardial infarction but can also rarely been seen in conditions such as arrhythmogenic right ventricular dysplasia.
The exact aetiology of lipom...
Lutembacher syndrome refers to the association of an atrial septal defect (ASD) with mitral stenosis. Both the defects can be either congenital or acquired.
History and etymology
It is named after Rene Lutembacher 4.
Lyme disease, also known as borreliosis, is a condition caused by the bacteria Borrelia burgdorferi, with infection being via the ixodid tick.
Controversy around Lyme disease centres on chronic infection with some author doubting its existence 3. There are some terms that help dif...
Major aortopulmonary collateral arteries (MAPCAs) are persistent tortuous fetal arteries that arise from the descending aorta and supply blood to pulmonary arteries in the lungs usually at the posterior aspect of hilum.
Embryologically, the intersegmental arteries regress with the no...
Marfan syndrome is a multisystem connective tissue disease with autosomal dominant inheritance of defect in fibrillin 1 gene. The affected patients are tall with long disproportionate extremities and have pectus excavatum, arachnodactyly, and may also experience upward and lateral optic lens dis...
Medical devices in the thorax are regularly observed by radiologists when reviewing radiographs and CTs.
tubing, clamps, syringes lying on or under the patient
rubber sheets, foam mattresses, clothing, hair braids, nipple piercings etc may also be visible
These devices ...
The middle cardiac vein or posterior interventricular vein is a vein of the heart which accompanies the posterior interventricular artery. It courses in the posterior interventricular groove and drains directly into the coronary sinus close to it’s termination. It drains the posterior wall of bo...
Milking effect phenomenon is a pathognomonic angiographic finding in myocardial bridging of coronary arteries. Systolic compression of coronary vessels with partial or complete decompression during diastole is described as milking effect. Its significance lies in:
increased risk of thrombus fo...
Minimally invasive direct coronary artery bypass (MIDCAB) is a novel method for bypassing diseased coronary arteries that can replace open coronary artery bypass grafts (CABG) in certain situations, most commonly when bypassing the left anterior descending artery (LAD) with a left internal thora...
A MitraClip™ is a device for percutaneous mitral valve repair. It is a percutaneous edge-to-edge attachment system that mimics the surgical procedure. This technique creates a tissue bridge between the anterior and posterior leaflets employing one clip deployed through trans-septal catheterisati...
Mitral annular calcification (MAC) refers to deposition of calcium (along with lipid) in the annular fibrosa of the mitral valve.
Annular calcification is seen in up to 35% of elderly patients. It is common in females over 65 years, in those with myxtomatous degeneration of the mi...
Mitral stenosis refers to stenosis of the mitral valve in the heart.
It is characterised by restriction of blood flow from the left atrium to the left ventricle as a result of a narrowed mitral passage. Mitral stenosis is usually an acquired valvular defect and historically, the comm...
The mitral valve (or bicuspid valve) is one of the four cardiac valves. It is the atrioventricular valve that allows blood to flow from the left atrium to the left ventricle. It opens during diastole and closes during systole. The valve has anterior and posterior leaflets (cusps), the bases of w...
Mitral valve calcification can refer to 1
mitral annular calcification (MAC) or
mitral valve leaflet calcification (MVL)
Mitral valve disease (MVD) principally comprise of a two main functional abnormalities, which can occur in isolation or in combination:
In addition other pathologies that affect the mitral valve include
mitral valve prolapse
mitral annular calcification
Mitral valve prolapse (MVP) is often defined as systolic bowing of the mitral leaflet more than 2 mm beyond the annular plane into the atrium 1. It is a common cause of mitral regurgitation (considered most frequent cause of severe non-ischaemic mitral regurgitation 2).
It may aff...
Mitral valve regurgitation is due to functional or anatomical dysfunction of the mitral valve and can lead to striking chest x-ray abnormalities.
The causes of mitral regurgitation are protean and, as such, there is no single group of patients who are affected. Mitral regurgitatio...
The moderator band, also called the septomarginal trabecula, is a consistent structure in the morphologic right ventricle and can be helpful as a landmark in situations where the ventricles may be ambiguous (i.e. in some forms of congenital heart disease).
The term "septomarginal" is descriptiv...
The 'moguls of the heart' refer to the bulges of the cardiomediastinal contour on frontal chest radiographs. The cardiomediastinal bulges are likened to skiing moguls (bumps of packed snow on a mountainside sculptured by turning skis). Awareness of their usual locations and aetiologies is helpfu...
The Mustard repair is a technique to correct transposition of the great arteries (TGA), and involves:
resection of atrial septum
creation of an atrial baffle with pericardium (or rarely synthetic material) 1
Transposition of the great arteries involves a discordance between the ven...
Myocardial bridging is a common congenital anomaly of the coronary arteries where a coronary artery courses through the myocardium.
It is found approximately in 20-30% of the adult population in autopsy studies. Incidence in coronary angiograms is between 2-15%.
Myocardial infarction (MI), an acute coronary syndrome, results from interruption of myocardial blood flow and resultant ischaemia, and are a leading cause of death worldwide.
male > females
> 45 for males
> 55 for females
cardiovascular risk factors: smokin...
Myocardial perfusion and viability assessment is important for many reasons:
to diagnose, locate and grade the severity of coronary artery disease
to identify candidates who would benefit from re-vascularization
to evaluate response of re-vascularization
Myocarditis is a general term referring to inflammation of the myocardium.
Clinical presentation is variable in severity, ranging from asymptomatic to cardiogenic shock, but it typically is associated with other viral symptom, including fever and malaise. It typically oc...
The napkin-ring sign (heart) is a recently described sign encountered on CT coronary angiogram (coronary CTA) performed on modern MDCT. It has been shown to possess a high predictive value in predicting future cardiac events and is considered one of the imaging correlates of an unstable plaque. ...
Non-compaction of the left ventricle, also known as spongiform cardiomyopathy, is an arrest of myocardial compaction during embryogenesis, leading to hypertrophic ventricular trabeculations and deep inter-ventricular recesses.
This abnormality has also been described in the right ventricular, b...
Nonbacterial thrombotic endocarditis (NBTE), also referred as marantic endocarditis, refers to fibrin and platelets aggregations on previously undamaged heart valves, in patients without bacteraemia. The condition is seen in patients with advanced stage malignancies, and is related to episodes o...
This article lists examples of normal imaging of the chest and surrounding structures, divided by modality.
PA adult male
example 2: with inverted windows
PA adult female
example 3: with labels
A detailed understanding of the structures that make up the normal contours of the heart and mediastinum (cardiomediastinal contour) on chest radiography is essential if abnormalities are to be detected.
Frontal view (PA/AP)
Right cardiomediastinal contour
From superior to inferior:
The Norwood procedure is a palliative surgical procedure performed in cases of hypoplastic left heart syndrome.
The procedure consists of constructing a neo-aorta by side-to-side anastomosis of the main pulmonary artery and ascending aorta. A modified Blalock-Taussig shunt is placed to provide ...
The oblique pericardial sinus is a blind-ending pericardial cul-de-sac behind the heart which opens into the pericardial space proper inferiorly.
It's boundaries are:
right (in ascending order): inferior vena cava, right inferior pulmonary vein and right superior pulmonary vein
The obtuse marginal (OM) arteries sometimes referred to as lateral branches are branch coronary arteries that come off the circumflex artery. There can be one or more obtuse marginal arteries. It typically traverses along the left margin of heart towards the apex. The first obtuse marginal arter...
Ortner syndrome, also known as cardiovocal syndrome, is characterised by hoarse voice resulting from left recurrent laryngeal nerve palsy secondary to a cardiovascular disorder.
Left recurrent laryngeal nerve palsy in this condition is due to traction or compression of the nerve betw...
A number of paediatric cardiovascular procedures are encountered when reporting paediatric imaging. They include:
Blalock-Taussig (BT) shunt
classic: end to side subclavian to ipsilateral pulmonary arterial anastomosis
modified: graft anastomosis
Sano shunt: right ventricle ...
Panzerherz (or armoured heart) is a term used to describe the appearance of the heart in calcified constrictive pericarditis.
The pericardium becomes circumferentially thickened with calcification, limiting the ability of the heart to contract. The rim of dense calcification describes how the h...
Papillary fibroelastomas are rare benign primary cardiac tumours. However, of the primary cardiac tumours, they are one of the commonest to occur in relation to the cardiac valves (may account for 75% of valvular tumours 10).
Its estimated prevalence ranges between <0.01 to 0.33%...
The papillary muscles are thick bands and ridges of endocardial-lined myocardium that project into the lumen of the cardiac ventricles. They essentially represent dominant ventricular trabeculae which attach to the cusps of the atrioventricular valves via the chordae tendineae. During systole, t...
A parachute device improves the cardiac output by partitioning damaged heart muscle in the apical region from normal muscle, allowing improvement of cardiac output and functioning of the left ventricle in patients with ischaemic heart failure secondary to infarction.
Implantation is accomplishe...
A parachute mitral valve is a valvular congenital abnormality usually identified in infants or young children though is can present later in adulthood.
Parachute mitral valves occur when all the chordae tendineae are attached to a single papillary muscle origin. Unlike the normal sit...
Partial anomalous pulmonary venous return (PAPVR), also known as partial anomalous pulmonary venous connection (PAPVC), is a rare congenital cardiovascular condition in which some of the pulmonary veins, but not all, drain into the systemic circulation rather than in the left atrium.
Passive hepatic congestion or congested liver in cardiac disease is the stasis of blood in the hepatic parenchyma, due to impaired hepatic venous drainage which leads to widening and splaying of the central hepatic veins and hepatomegaly.
Passive hepatic congestion is a well-studied result of ...
Patent ductus arteriosus or arteriosum (PDA) is a congenital cardiac anomaly where there is persistent patency of the ductus arteriosus, a normal connection of the fetal circulation between the aorta and the pulmonary arterial system that develops from the 6th aortic arch.
A patent foramen ovale (PFO) is a type of atrial septal defect in which there is channel-like communication between the atria through an unfused fossa ovale.
The foramen ovale in the interatrial septum normally develops into the fossa ovalis when the flaps of the atrial septa pri...
The pectinate muscles are "teeth of a comb" shaped parallel muscular columns that are present on the inner wall of the right and left atria.
The right atrium has thick and coarse pectinate muscles while these are few smooth and thinner in the left atrium.
History and etymology
The term is der...
The pentalogy of Fallot is a variant of the more common tetralogy of Fallot, comprising the classical four features with the addition of an atrial septal defect or patent ductus arteriosus The five features therefore are:
ventricular septal defect (VSD)
right ventricular outlfow tract narro...
Peri-partum/post-partum cardiomyopathy is a dilated cardiomyopathy that may occur in the last trimester of pregnancy through the first several months post-partum.
The pathogenesis of post-partum cardiomyopathy is uncertain, with genetic factors, sympathetic tone, hormones, and malnut...
Pericardial agenesis is a rare condition where there is the absence of the pericardium to varying degrees. If it is only a small portions of the pericardium that is absent it is known as a pericardial defect.
According to a surgical and pathological series, the prevalence (inclusi...
Pericardial cysts are uncommon benign congenital anomalies of the anterior and middle mediastinum.
Usually asymptomatic and discovered incidentally although occasionally may present with chest pain and dyspnoea.
They are thought to often result from aberration...
Pericardial effusions occur when excess fluid collects in the pericardial space (a normal pericardial sac contains approximately 30-50 mL of fluid).
There is no single demographic affected, as there are many underlying causes of a pericardial effusion.
Pericardial haemangioma is a location specific rare subtype of cardiac haemangioma which arises from either the parietal or visceral (commoner 3) pericardial layers.
Treatment and prognosis
It is a benign tumour. Treatment option vary from monitoring to resection.
The pericardial ligaments is a name given to a group of variable fibrous ligaments or adhesions that connect the pericardium to adjacent structures. These ‘ligaments’ tether the fibrous pericardium to it's surrounds, hence movements of the chest wall and diaphragm influence the position of the ...
Pericardial lipoblastomas are rare benign tumours that usually occur in children less than 3 years of age. The originate from embryonic fat cells and are divided into two forms, based on location 1:
superficial form: well circumscribed and well encapsulated
deep form: not well circumscribed an...
Pericardial lipomas are slowly growing benign tumours of the pericardium that are asymptomatic unless large in size, where they can cause pressure symptoms.
Tends to be echogenic structure adjacent or inside the pericardium.
Seen as a fatty attenuat...
Pericardial mesothelioma refers to a mesothelioma arising primarily from the pericardium.
They are rare and are only thought to account for ~ 0.7% of all malignant mesotheliomas. There is male to female predominance of approximately 3:1.
The presentation o...
The pericardial recesses are small spaces in the pericardial cavity arising from the transverse pericardial sinus that are formed by the reflections of the pericardium. Pericardial fluid can pool in these recesses, mimicking mediastinal lymph nodes or pathology. There are several pericardial re...
The pericardial space or cavity is the fluid-filled space in between the parietal and visceral layers of the serous pericardium. In normal conditions it contains only a small amount of serous pericardial fluid, usually 15-20 mL.
A pericardial effusion is the pathological accu...
There are a number of tumours that can involve the pericardium. They include
primary pericardial tumours
primary pericardial mesothelioma
primary pericardial lymphoma
Pericardial window is a procedure performed to create a fistula or "window" from the pericardial space to the pleural space. It is done to allow a pericardial effusion to drain the chest cavity in order to relieve situations with increased pressures such as with cardiac tamponade.
Pericarditis is defined as inflammation of the pericardium. It is normally found in association with cardiac, thoracic or wider systemic pathology and it is unusual to manifest on its own.
In general, infection is the most common cause of pericarditis. Infection accounts for two-thir...
The pericardium is a conical, flask-like, fibroserous sac which contains the heart and the roots of the great vessels and defines the middle mediastinum.
The pericardium is made of two sacs in one. The outer sac is the fibrous pericardium and the inner sac is the double-layered ...