"Evaluation of Chest Radiograph in Children with Heart Disease," by George Taylor for OPENPediatrics

In this video, Dr. George Taylor outlines the approach to evaluating chest radiographs in children with known or suspected heart disease. Dr. Taylor discusses evaluation of the heart, pulmonary vasculature, airway, and situs of the chest and abdomen.

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My name is George Taylor from the Department of Radiology at Boston Children's Hospital. And in this session we're going to be talking about how to evaluate the chest radiograph in children with known or suspected heart disease. We will be following a systematic approach to the evaluation of the chest x-ray focusing on the heart, the pulmonary vasculature, airway, the situs of the abdomen and chest, and bony abnormalities.

Heart.

In terms of the heart, we need to look at the size of the heart and, whenever possible, the presence of specific chamber enlargement. The factors that generally increase heart size are increased volume within the heart, obstruction to that specific chamber, pump failure, pericardial diseases, and associated heart or mediastinal masses. Here, our first child we have an eight-month-old who presents with cyanosis and a murmur.

And we see that there is diffuse cardiomegaly, but specific enlargement of the right atrium. The atrium is bulging laterally, and on the lateral view, we can see that the right atrium also extends behind the trachea. This is a congenital abnormality of the tricuspid valve with enlargement of the right atrium, atrialization of the right ventricle, and often associated with decreased pulmonary vascularity.

Here is another child with a large heart. A 14-year-old who presents with fever, arthralgias, and shortness of breath who has rheumatic fever. In this child with mitral valve disease, we can see enlargement of the right atrium, with enlargement of the right atrial appendage as well, and displacement of the posterior heart border behind the trachea, which is a good sign of left atrial enlargement.

This six-month-old with respiratory distress has diffuse cardiomegaly and under inflated chest as a result of a dilated cardiomyopathy. In this situation, looking at specific chamber enlargement in an infant can be very, very difficult. This eight-year-old presenting with shortness of breath has a "globular" looking heart.

It's enlarged, but the contours are slightly different in that they more resemble a bag full of water, rather than specific chamber enlargement. So when we see a child with a large heart, we need to consider the possibility that either the heart is enlarged, or there is fluid surrounding the heart, so that the shadow of the hard looks much bigger than it normally is.

Here the same child is shown after a drainage catheter has been put in the pericardium, and you can see a marked difference in the size of the heart.

Видео "Evaluation of Chest Radiograph in Children with Heart Disease," by George Taylor for OPENPediatrics канала OPENPediatrics