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What is your Radiological Diagnosis?

Tags: karuturi.cardiology.rounds

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Abdul Razek Maaty: This is an aneurysmal dilatation of the pulmonary artery and its two main branches for differential diagnosis: 3 main causes (hypertensive ASD, hypertensive MS, Bilharzial Cor pulmonale). We used to see this CXR in our locality in Egypt frequently because of the high prevalence of Schistosomiasis and rheumatic fever but to reach this size of pulmonary artery, we see it usually with Bilharzial cor pulmonle. Rapid look with 2D echo will solve the quiz within seconds.
The correct answer is Atrial Septa Defect.

The chest xray shows
- Cardiomegaly
- Aortic Knuckle inconspicuous
- Pulmonary conus grossly dilates
- RDPA - prominent and larger than trachea
- Pruning of the pulmonary artery
- Shunt vasculature present
- Pulmonary parenchyma hazy
- Upper lung fields clear

Chest Xray s/o intracardiac left to right shunt with pulmonary arterial hypertension - ?ASD ?VSD

Echocardiography of this patient revealed a Ostium Secundum type of ASD.

Chest X-ray in Atrial Septal Defect

Advantages/disadvantages

Advantages:

* Noninvasive
* Relatively inexpensive
* Low risk with little radiation exposure

Disadvantages:

* Not sensitive or specific for ASD or PFO
* Many false-positive and false-negative results

Abnormal

* Prominent right heart silhouette
* Prominence of the main pulmonary arteries

Cause of abnormal result

Increased blood flow to the right heart (from flow across the ASD) causes ventricular dilation and increases in pulmonary artery blood flow and pressure.
Dear Dr. Karuturi,
Thanks for this Fantastic CXR. Your diagnosis is an echocardiographic one. For me and others with no previous informations about the echo diagnosis, the best answer is differential diagnosis betwwen various causes of aneurysmally dilated pulmonary artery. You said, the diagnosis is ASD. Please, tell me the X-ray criteria in this picture that suggest ASD.

Best Wishes,
Abdul Razek Maaty.

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