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Karuturi Cardiology Rounds 2 > What is your Radiological Diagnosis?
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Permalink Reply by Abdul Razek Abdul Lateef Maaty on -
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.
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Permalink Reply by Subrahmanyam Karuturi on -
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.
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Permalink Reply by Abdul Razek Abdul Lateef Maaty on
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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.
