Mission
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- CHF and the Chest X-ray
- Practical Approach
- Anatomical considerations
- Histological Considerations
- Physiology/Pathophysiology
Principles
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- Key anatomical issues
?Size of the LA
?Ratio branch pulmonary arteries to bronchus
?Relative size of the upper vessels to lower vessels
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- Key Histological issues
?Secondary lobule
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- Key Physiology and Pathophysiological
?LVEDP
?Wedge pressures
2 Major Questions
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Is the LA Enlarged?
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Is it an LA with a 10 mmHg, 20 mmHg or 30 mmHg pressure
And then 3 other questions
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- Is the PA>Bronchus in the middle or upper lobe vessels
- Is there fuzziness to the vessels?
- Is there alveolar edema?
1) Is the LA Enlarged?
The Normal Angle – Angle of the Crotch in a Walk
CXR and CHF
Ashley Davidoff MD
The Wright Brothers 1910
The Kick or the Dance –
Widening of the carinal (crotch) angle
Is it an LA with a 10 mmHg, 20 mmHg or 30 mmHg pressure
Question 1
In the Upper Lung Fields
Is the PA Equal to or Bigger than the Bronchus
If so….. LA pressurr is at least 10 mmHg
CXR and CHF
Ashley Davidoff MD
Example of PA Larger than the Bronchus
Question 2
Is there fuzziness of the vessels?
ie Is there interstitial edema?
Then LA Pressure is at least 20 mmHg
Kerley B Line and Peribronchial Cuffing
Question 3
Are there perihilar batwing infiltrates?
ie Is there alveolar edema?
Then LA pressure is at least 30 mmHg
TOP left image is of normal alveoli
Top Rt is PA slightly greater than bronchus = LVEDP 10-20 mmHg
Bottom left = 20-30 interstitial edema – peribronchial cuffing and Kerley B
Bottom Rt >30 = Alveolar Edema
The Carina
NORMAL FRONTAL CXR NORMAL ASYMMETRIC BRANCHING OF MAINSTEM BRONCHI
The normal CXR shows the characteristic asymmetric branching of the main stem bronchi. The right is short and stout and slightly more vertical while the left is long and thin and slightly more obtuse.
The normal carinal angle is between 40-80 degrees.
Ashley Davidoff MD 30397c02L.8
UPPER LOBE PA TO BRONCHUS RATIO – NORMAL
Cephalisation
Interstitial edema
41F 1 year ago
Presents with SOB Left Sided BE
References and Links
- TCV
- Cases