Chest radiographic interpretation in pediatric cardiac patients PDF
Preview Chest radiographic interpretation in pediatric cardiac patients
Chest Radiographic Interpretation in Pediatric Cardiac Patients Chest Radiographic Interpretation in Pediatric Cardiac Patients Shi-Joon Yoo, MD, PhD, FRCPC Section Head of Cardiac Imaging Department of Diagnostic Imaging Hospital for Sick Children Professor Departments of Medical Imaging and Paediatrics University of Toronto Toronto, Canada Cathy MacDonald, MD, FRCPC Radiologist Department of Diagnostic Imaging Hospital for Sick Children Assistant Professor Department of Medical Imaging University of Toronto Toronto, Canada Paul Babyn, MD, FRCPC Radiologist-in-Chief Department of Diagnostic Imaging Hospital for Sick Children Associate Professor Department of Medical Imaging University of Toronto Toronto, Canada Thieme New York • Stuttgart Thieme Medical Publishers, Inc. 333 Seventh Ave. New York, NY 10001 Editorial Director: Michael Wachinger Managing Editor: Timothy Y. Hiscock Editorial Assistant: Jacquelyn DeSanti International Production Director: Andreas Schabert Production Editor: Kenneth L. Chumbley, Publication Services Vice President, International Marketing and Sales: Cornelia Schulze Chief Financial Officer: James W. Mitos President: Brian D. Scanlan Compositor: Thomson Digital Printer: Sheridan Books, Inc. Library of Congress Cataloging-in-Publication Data Chest radiographic interpretation in pediatric cardiac patients / [edited by] Shi-Joon Yoo, Cathy MacDonald, Paul Babyn. p. ; cm. Includes bibliographical references. ISBN 978-1-60406-036-2 (alk. paper) 1. Pediatric cardiology—Diagnosis. 2. Pediatric radiography. I. Yoo, Shi-Joon. II. MacDonald, Cathy, MD. III. Babyn, Paul S. [DNLM: 1. Heart Diseases—radiography. 2. Child. 3. Infant. 4. Radiography, Thoracic. WS 290 C525 2010] RJ423.C44 2010 618.92’1207572—dc22 2009043190 Copyright ©2010 by Thieme Medical Publishers, Inc. 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However, in view of the possibility of human error by the authors, editors, or publisher of the work herein or changes in medical knowledge, neither the authors, editors, nor publisher, nor any other party who has been involved in the preparation of this work, warrants that the information contained herein is in every respect accurate or complete, and they are not responsible for any errors or omissions or for the results obtained from use of such information. Readers are encouraged to confirm the information contained herein with other sources. For example, readers are advised to check the product information sheet included in the package of each drug they plan to administer to be certain that the information contained in this publication is accurate and that changes have not been made in the recommended dose or in the contraindications for administration. This recommendation is of particular importance in connection with new or infrequently used drugs. 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Printed in the United States of America 5 4 3 2 1 ISBN 978-1-60406-036-2 Contents Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii Alan Daneman, MD Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix Andrew Redington, MD Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv Abbreviations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xvii Section I Getting Started . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1. Normal Cardiovascular Anatomy for Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Shi-Joon Yoo and Donald G. Perrin 2. Sequential Segmental Approach to Congenital Heart Disease. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 3. Basic Cardiac Function and Hemodynamics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Derek Wong and Shi-Joon Yoo 4. Glossary of Pediatric Cardiovascular Surgical Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Shi-Joon Yoo and Christopher A. Caldarone 5. The Best Radiographs with the Least Radiation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Ellen Charkot and Shi-Joon Yoo Section II Systematic Approach to Chest Radiographs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 6. Identification, Clinical History, and Radiographic Techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 7. Visceral Situs, Heart Position, and Aortic Arch Position . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 8. Heart Size, Overall Configuration, and Specific Chamber Enlargement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 9. Pulmonary Vascularity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104 10. Aorta and Systemic Veins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132 11. Airways, Lungs, Pleurae, Mediastinum, Diaphragm, and Chest Wall . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142 Section III Individual Heart Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175 12. Lesions with Left-to-Right Shunt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177 With Christian J. Kellenberger 13. Truncus Arteriosus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185 With Christian J. Kellenberger 14. Ebstein’s Malformation and Other Forms of Congenital Tricuspid Regurgitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189 With Christian J. Kellenberger v vi Contents 15. Tetralogy of Fallot and Related Conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193 With Christian J. Kellenberger 16. Pulmonary Valvar Stenosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 200 With Christian J. Kellenberger 17. Pulmonary Atresia with Intact Ventricular Septum. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203 With Christian J. Kellenberger 18. Partial and Total Anomalous Pulmonary Venous Connections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 206 With Monica Epelman 19. Congenital Stenosis and Atresia of the Individual Pulmonary Veins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215 With Anne Geoffray 20. Abnormalities of the Mitral Valve and Related Anomalies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219 With Anne Geoffray 21. Obstructive Lesions of the Left Ventricular Outflow Tract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 222 With Monica Epelman 22. Hypoplastic Left Heart Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 225 With Monica Epelman 23. Obstructive Lesions of the Aortic Arch . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229 With Monica Epelman 24. Transpositions of the Great Arteries. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 234 With Kevin S. Roman 25. Double-Outlet Ventricles. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 241 With Kevin S. Roman 26. Hearts with Single-Ventricle Physiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243 With Kevin S. Roman 27. Abnormal Situs and Cardiac Malposition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 247 With Kevin S. Roman 28. Rheumatic Fever and Acquired Valvular Heart Diseases. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 257 With Christian J. Kellenberger and Kevin S. Roman 29. Cardiomyopathies and Related Conditions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 262 With Kevin S. Roman 30. Kawasaki Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 268 With Kevin S. Roman 31. Pericardial Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 271 With Christian J. Kellenberger 32. Cardiac Tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 275 With Christian J. Kellenberger 33. Pulmonary Thromboembolism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 279 With Anne Geoffray 34. Pulmonary Hypertension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 281 With Anne Geoffray Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 285 Foreword Appropriate management of children with cardiovascular At the Hospital for Sick Children, Toronto, Canada, disease in the 21st century relies heavily on an armamen- there has long been a close relationship between the tarium of sophisticated imaging techniques, such as echo- pediatric radiologists, whose prime interest has been in cardiography, computed tomography, magnetic resonance cardiovascular disease, and the pediatric cardiologists imaging (including functional techniques), angiography, and cardiac surgeons. This close relationship began and interventional procedures guided by angiography. No decades ago, when the cardiac radiologist Dr. Fred Moes modern hospital can provide appropriate care for the forged a close collaboration with Drs. Rowe, Mustard, child with cardiovascular disease without the availability and Freedom in cardiology and cardiovascular surgery. of this full range of modalities. Over the years, other outstanding cardiac radiologists Plain radiographs of the chest are still used in these have joined the staff, such as Gordon Culham and children at the time of their initial presentation and PatBurrows and more recently Shi-Joon Yoo and Cathy during follow-up of medical management and after cor- MacDonald. rective surgical or interventional procedures. Although This collaboration has led to the publication of many the plain radiograph does not provide the definitive outstanding papers and books on the subject of pediatric anatomic and functional information depicted by the cardiovascular disease. The present book on interpreta- more sophisticated modalities, it serves as an initial part tion of the plain radiograph in these patients finds its of the evaluation at the time of the diagnosis and is essen- niche by filling a specific area of interest among the other tial (usually repeatedly) following surgical correction. books on pediatric cardiovascular diseases published Accurate interpretation of the plain radiograph of the from this institution. chest therefore remains vitally important. However, in The information in this book is important not only to recent decades there has been tremendous interest in the pediatric cardiovascular radiologists but also to pediatric newer, more exciting, sophisticated modalities, and more cardiologists and cardiac surgeons. The book will become time has been spent learning how to derive maximum standard reading for all those training in these specialties. information from these modalities. In this era, learning to The manner in which it has been written and illustrated optimize the interpretation of plain radiographic findings will reignite interest in the interpretation of the plain often assumes a less important role. chest radiograph even for those whose main interest is in This book, authored by Drs. Yoo, MacDonald, and Babyn, the more sophisticated modalities. highlights the plain radiographic interpretation in cardio- vascular abnormalities manifesting in neonates, infants, Dr. Alan Daneman and children. The information is presented in an organized Professor of Medical Imaging and interesting manner. The quality of the illustrations is University of Toronto outstanding, and they are accompanied by extremely clear Head of Body Imaging and straightforward explanations of the findings. The text Department of Diagnostic Imaging also describes the common cardiovascular surgical proce- Hospital for Sick Children dures (past and present) in detail to facilitate the under- Toronto, Canada standing of what can be expected to be found on the chest radiograph in these conditions postoperatively. vii Foreword It is with great pleasure that I write this foreword to Drs. Yoo, the authors for their painstaking collection and analysis MacDonald, and Babyn’s tour de force, Chest Radiographic on our behalf. Accrued over the course of five years, and Interpretation in Pediatric Cardiac Patients. representing many thousands of hours of analysis, illus- With the ever-increasing technology available to image tration, writing, and production, this book is a credit not cardiovascular disease, it is sometimes easy to forget the only to Drs. Yoo, MacDonald, and Babyn, but also to the value of basic clinical assessment and investigations. If combined Divisions of Cardiology and Radiology at the ever there was an illustration that such an evolution was Hospital for Sick Children. I am proud to be associated mistaken, it exists in this text. The extraordinary wealth with the authors and, in this small way, with the book of diagnostic and therapeutic information that may exist itself. within the chest radiograph shouts out from almost every page of this extraordinary contribution. Replete with Andrew Redington, MD up-to-the-minute examples of virtually every abnormality Head, Division of Cardiology imaginable, I am convinced that this book will rapidly Department of Paediatrics establish itself as a seminal work in the field. Hospital for Sick Children On behalf of all of the potential readers of this text, University of Toronto I would like to commend the extraordinary efforts of Toronto, Canada ix
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