Pulmonic regurgitation Chest X-Ray

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Pulmonic regurgitation Microchapters

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Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differential diagnosis

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Electrocardiogram

Chest X-Ray

Echocardiography

Cardiac MRI

Severity Assessment

Treatment

Medical Therapy

Surgical therapy

Follow up

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1], Associate Editor(s)-in-Chief: Aravind Kuchkuntla, M.B.B.S[2], Aysha Anwar, M.B.B.S[3], Javaria Anwer M.D.[4]

Overview

Chest x ray may not be required for the diagnosis of pulmonic regurgitation (PR). However, lateral and PA view of chest radiograph may help determining the right ventricular enlargement. Right atrial enlargement may also be seen among patients with concomitant tricuspid regurgitation. On plain chest X ray PR may be characterized by right ventricular enlargement, prominent pulmonary trunk, features of tricuspid regurgitation (TR), and of congestive heart failure (CHF).

Chest X ray

Right ventricular enlargement[3][4]:

Tetralogy of Fallot (TOF)

Prominent pulmonary trunk[8]

Carcinoid heart disease

Demonstration of Right Ventricular Enlargement

An illustration of right ventricular enlargement on PA view. The picture demonstrates the uplifting of cardiac apex - Case courtesy of Dr Vincent Tatco, Radiopaedia.org, rID: 46378


An illustration of right ventricular enlargement on lateral view - Case courtesy of Dr Vincent Tatco, Radiopaedia.org, rID: 46378


Chest X-ray Examples

Boot shaped heart demonstrated in Tetralogy of Fallot(TOF). The shoe tip is due to upturned cardiac apex owing to right ventricular hypertrophy, heel due to rounded right margin of the heart, and the top of the boot is due to a concave pulmonary arterial segment- Case courtesy of Dr Vincent Tatco, Radiopaedia.org, rID: 43059


Chest X ray PA view demonstrating pulmonary artery hypertension. An enlarged cardiac silhouette with prominent pulmonary trunk and pulmonary arteries proximally is also demonstrated - Case courtesy of Assoc Prof Frank Gaillard, Radiopaedia.org, rID: 8653


References

  1. https://radiopaedia.org/articles/right-ventricular-enlargement Accessed on 3rd January, 2017
  2. "Pulmonary valve regurgitation | Radiology Reference Article | Radiopaedia.org".
  3. 3.0 3.1 Shin, Yu Rim; Jung, Jo Won; Kim, Nam Kyun; Choi, Jae Young; Kim, Young Jin; Shin, Hong Ju; Park, Young-Hwan; Park, Han Ki (2016). "Factors associated with progression of right ventricular enlargement and dysfunction after repair of tetralogy of Fallot based on serial cardiac magnetic resonance imaging". European Journal of Cardio-Thoracic Surgery. 50 (3): 464–469. doi:10.1093/ejcts/ezw049. ISSN 1010-7940.
  4. 4.0 4.1 O'Meagher S, Ganigara M, Tanous DJ, Celermajer DS, Puranik R (June 2014). "Progress of right ventricular dilatation in adults with repaired tetralogy of Fallot and free pulmonary regurgitation". Int J Cardiol Heart Vessel. 3: 28–31. doi:10.1016/j.ijchv.2014.02.003. PMC 5801270. PMID 29450166.
  5. "Right ventricular enlargement | Radiology Reference Article | Radiopaedia.org".
  6. Bouzas, Beatriz; Kilner, Philip J.; Gatzoulis, Michael A. (2005). "Pulmonary regurgitation: not a benign lesion". European Heart Journal. 26 (5): 433–439. doi:10.1093/eurheartj/ehi091. ISSN 0195-668X.
  7. Hiader EA. The boot-shaped heart sign. Radiology, 2008; 246 (1):328-9.
  8. "Enlarged pulmonary trunk on chest radiography (differential) | Radiology Reference Article | Radiopaedia.org".
  9. Fox DJ, Khattar RS (October 2004). "Carcinoid heart disease: presentation, diagnosis, and management". Heart. 90 (10): 1224–8. doi:10.1136/hrt.2004.040329. PMC 1768473. PMID 15367531.