Pulmonic regurgitation Chest X-Ray: Difference between revisions

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==Chest X ray==
==Chest X ray==
There are no [[chest x ray]] findings required for the diagnosis of [[pulmonic regurgitation]]. However, lateral and [[PA view]] of chest radiograph may help determine the complications and associated conditions of [[PR]], which include [[right ventricle|right ventricular]] enlargement. [[Right atrial enlargement]] may also be seen in [[patients]] with concomitant [[tricuspid regurgitation]].<ref name=abc>https://radiopaedia.org/articles/right-ventricular-enlargement Accessed on 3rd January, 2017</ref>
*There are no [[chest x ray]] findings required for the diagnosis of [[pulmonic regurgitation]]. However, lateral and [[PA view]] of chest radiograph may help determine the complications and associated conditions of [[PR]], which include [[right ventricle|right ventricular]] enlargement. [[Right atrial enlargement]] may also be seen in [[patients]] with concomitant [[tricuspid regurgitation]].<ref name=abc>https://radiopaedia.org/articles/right-ventricular-enlargement Accessed on 3rd January, 2017</ref>
*On [[CXR]] of a [[patient]] with [[PR]] secondary to [[pulmonary hypertension]] (PAH), featurs demonstrating [[PAH]] may include
*On plain chest Xray [[PR]] may be characterized by<ref name="urlPulmonary valve regurgitation | Radiology Reference Article | Radiopaedia.org">{{cite web |url=https://radiopaedia.org/articles/pulmonary-valve-regurgitation?lang=us |title=Pulmonary valve regurgitation &#124; Radiology Reference Article &#124; Radiopaedia.org |format= |work= |accessdate=}}</ref><ref name="ShinJung2016">{{cite journal|last1=Shin|first1=Yu Rim|last2=Jung|first2=Jo Won|last3=Kim|first3=Nam Kyun|last4=Choi|first4=Jae Young|last5=Kim|first5=Young Jin|last6=Shin|first6=Hong Ju|last7=Park|first7=Young-Hwan|last8=Park|first8=Han Ki|title=Factors associated with progression of right ventricular enlargement and dysfunction after repair of tetralogy of Fallot based on serial cardiac magnetic resonance imaging|journal=European Journal of Cardio-Thoracic Surgery|volume=50|issue=3|year=2016|pages=464–469|issn=1010-7940|doi=10.1093/ejcts/ezw049}}</ref><ref name="pmid29450166">{{cite journal |vauthors=O'Meagher S, Ganigara M, Tanous DJ, Celermajer DS, Puranik R |title=Progress of right ventricular dilatation in adults with repaired tetralogy of Fallot and free pulmonary regurgitation |journal=Int J Cardiol Heart Vessel |volume=3 |issue= |pages=28–31 |date=June 2014 |pmid=29450166 |pmc=5801270 |doi=10.1016/j.ijchv.2014.02.003 |url=}}</ref>:
*On [[CXR]], [[right heart failure]] (RHF) which may be a complication of [[PR]] is chracterised by [[right ventricle|right ventricular]] enlargement. [[Right ventricle|right ventricular]] enlargement od PA view demonstrates rounded [[Left margin of heart|left heart border]] and uplifted [[cardiac apex]]. On lateral view, filling of the retro[[sternum|sternal]] space and rotation of the [[heart]] posteriorly.<ref name="urlRight ventricular enlargement | Radiology Reference Article | Radiopaedia.org">{{cite web |url=https://radiopaedia.org/articles/right-ventricular-enlargement?lang=us |title=Right ventricular enlargement &#124; Radiology Reference Article &#124; Radiopaedia.org |format= |work= |accessdate=}}</ref> [[CXR]] has limited utility in the diagnosis of [[Right heart failure|RHF]].<ref name="BouzasKilner2005">{{cite journal|last1=Bouzas|first1=Beatriz|last2=Kilner|first2=Philip J.|last3=Gatzoulis|first3=Michael A.|title=Pulmonary regurgitation: not a benign lesion|journal=European Heart Journal|volume=26|issue=5|year=2005|pages=433–439|issn=0195-668X|doi=10.1093/eurheartj/ehi091}}</ref>
*#[[Right ventricle|Right ventricular]] enlargement (specially in [[patients]] with surgical repair of [[TOF]])
*#Prominent [[pulmonary trunk]]
*#Features of [[tricuspid regurgitation]] (TR) may also be present. To read more about CXR findings associated with TR, [[Tricuspid regurgitation chest x ray|click here]].
*#Features of [[congestive heart failure]] (CHF) may also be present. To read more about CXR findings associated with CHF, [[Congestive heart failure chest x ray|click here]].
 
 
===[[Right ventricle|Right ventricular]] enlargement<ref name="ShinJung2016">{{cite journal|last1=Shin|first1=Yu Rim|last2=Jung|first2=Jo Won|last3=Kim|first3=Nam Kyun|last4=Choi|first4=Jae Young|last5=Kim|first5=Young Jin|last6=Shin|first6=Hong Ju|last7=Park|first7=Young-Hwan|last8=Park|first8=Han Ki|title=Factors associated with progression of right ventricular enlargement and dysfunction after repair of tetralogy of Fallot based on serial cardiac magnetic resonance imaging|journal=European Journal of Cardio-Thoracic Surgery|volume=50|issue=3|year=2016|pages=464–469|issn=1010-7940|doi=10.1093/ejcts/ezw049}}</ref><ref name="pmid29450166">{{cite journal |vauthors=O'Meagher S, Ganigara M, Tanous DJ, Celermajer DS, Puranik R |title=Progress of right ventricular dilatation in adults with repaired tetralogy of Fallot and free pulmonary regurgitation |journal=Int J Cardiol Heart Vessel |volume=3 |issue= |pages=28–31 |date=June 2014 |pmid=29450166 |pmc=5801270 |doi=10.1016/j.ijchv.2014.02.003 |url=}}</ref>:===
*Progressive [[right ventricle|right ventricular]] enlargement is common among [[patients]] with [[PR]] after [[TOF]] repair.
*On [[CXR]], [[right heart failure]] (RHF) is chracterised by [[right ventricle|right ventricular]] enlargement.  
**[[Right ventricle|Right ventricular]] enlargement on PA view demonstrates rounded [[Left margin of heart|left heart border]] and uplifted [[cardiac apex]].  
**On lateral view, filling of the retro[[sternum|sternal]] space and rotation of the [[heart]] posteriorly.<ref name="urlRight ventricular enlargement | Radiology Reference Article | Radiopaedia.org">{{cite web |url=https://radiopaedia.org/articles/right-ventricular-enlargement?lang=us |title=Right ventricular enlargement &#124; Radiology Reference Article &#124; Radiopaedia.org |format= |work= |accessdate=}}</ref> [[CXR]] has limited utility in the diagnosis of [[Right heart failure|RHF]].<ref name="BouzasKilner2005">{{cite journal|last1=Bouzas|first1=Beatriz|last2=Kilner|first2=Philip J.|last3=Gatzoulis|first3=Michael A.|title=Pulmonary regurgitation: not a benign lesion|journal=European Heart Journal|volume=26|issue=5|year=2005|pages=433–439|issn=0195-668X|doi=10.1093/eurheartj/ehi091}}</ref>
===[[Tetralogy of Fallot]] (TOF)===
*On [[CXR]] of a [[patient]] with [[PR]] as a complication of [[TOF|tetrology of Fallot]] (TOF) repair, a “boot shaped” heart may be demonstrated.<ref>Hiader EA. The boot-shaped heart sign. Radiology, 2008; 246 (1):328-9.</ref>
*On [[CXR]] of a [[patient]] with [[PR]] as a complication of [[TOF|tetrology of Fallot]] (TOF) repair, a “boot shaped” heart may be demonstrated.<ref>Hiader EA. The boot-shaped heart sign. Radiology, 2008; 246 (1):328-9.</ref>
===Prominent [[pulmonary trunk]]===
*On [[CXR]] of a [[patient]] with [[PR]] secondary to [[pulmonary hypertension]] (PAH), featurs demonstrating [[PAH]] may include prominent [[pulmonary trunk]] and broadened [[mediastinum]].
==Demonstration of Right Ventricular Enlargement==
==Demonstration of Right Ventricular Enlargement==
[[File:Right-ventricular-enlargement-on-chest-radiography-illustration.png|thumb|350px|left|An illustration of [[right ventricle|right ventricular]] enlargement on PA view. The picture demonstrates the uplifting of [[cardiac apex]] - Case courtesy of Dr Vincent Tatco, Radiopaedia.org, rID: 46378]]
[[File:Right-ventricular-enlargement-on-chest-radiography-illustration.png|thumb|350px|left|An illustration of [[right ventricle|right ventricular]] enlargement on PA view. The picture demonstrates the uplifting of [[cardiac apex]] - Case courtesy of Dr Vincent Tatco, Radiopaedia.org, rID: 46378]]
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==Chest X-ray Examples==
==Chest X-ray Examples==
[[File:Tetralogy-of-fallot-6.jpg|thumb|350px|left|Boot shaped heart demonstrated in Tetralogy of Fallot(TOF). The shoe tip is due to upturned [[cardiac apex]] owing to [[right ventricular hypertrophy]] and a concave pulmonary arterial segment gives rise to the top of boot- Case courtesy of Dr Vincent Tatco, Radiopaedia.org, rID: 43059]]
[[File:Tetralogy-of-fallot-6.jpg|thumb|350px|left|Boot shaped heart demonstrated in Tetralogy of Fallot(TOF). The shoe tip is due to upturned [[cardiac apex]] owing to [[right ventricular hypertrophy]], heel due to rounded right margin of the [[heart]], and the top of the boot is due to a concave pulmonary arterial segment- Case courtesy of Dr Vincent Tatco, Radiopaedia.org, rID: 43059]]
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Revision as of 15:20, 4 August 2020

Pulmonic regurgitation Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1], Associate Editor(s)-in-Chief: Aravind Kuchkuntla, M.B.B.S[2], Aysha Anwar, M.B.B.S[3]

Overview

Chest x ray may not be required for the diagnosis of pulmonic regurgitation (PR). However, lateral and PA view of chest radiograph may help determining the right ventricular enlargement. Right atrial enlargement may also be seen in patients with concomitant tricuspid regurgitation.[1]

Chest X ray


Right ventricular enlargement[3][4]:

Tetralogy of Fallot (TOF)

Prominent pulmonary trunk

Demonstration of Right Ventricular Enlargement

An illustration of right ventricular enlargement on PA view. The picture demonstrates the uplifting of cardiac apex - Case courtesy of Dr Vincent Tatco, Radiopaedia.org, rID: 46378


An illustration of right ventricular enlargement on lateral view - Case courtesy of Dr Vincent Tatco, Radiopaedia.org, rID: 46378


Chest X-ray Examples

Boot shaped heart demonstrated in Tetralogy of Fallot(TOF). The shoe tip is due to upturned cardiac apex owing to right ventricular hypertrophy, heel due to rounded right margin of the heart, and the top of the boot is due to a concave pulmonary arterial segment- Case courtesy of Dr Vincent Tatco, Radiopaedia.org, rID: 43059



References

  1. ↑ 1.0 1.1 https://radiopaedia.org/articles/right-ventricular-enlargement Accessed on 3rd January, 2017
  2. ↑ "Pulmonary valve regurgitation | Radiology Reference Article | Radiopaedia.org".
  3. ↑ 3.0 3.1 Shin, Yu Rim; Jung, Jo Won; Kim, Nam Kyun; Choi, Jae Young; Kim, Young Jin; Shin, Hong Ju; Park, Young-Hwan; Park, Han Ki (2016). "Factors associated with progression of right ventricular enlargement and dysfunction after repair of tetralogy of Fallot based on serial cardiac magnetic resonance imaging". European Journal of Cardio-Thoracic Surgery. 50 (3): 464–469. doi:10.1093/ejcts/ezw049. ISSN 1010-7940.
  4. ↑ 4.0 4.1 O'Meagher S, Ganigara M, Tanous DJ, Celermajer DS, Puranik R (June 2014). "Progress of right ventricular dilatation in adults with repaired tetralogy of Fallot and free pulmonary regurgitation". Int J Cardiol Heart Vessel. 3: 28–31. doi:10.1016/j.ijchv.2014.02.003. PMC 5801270. PMID 29450166.
  5. ↑ "Right ventricular enlargement | Radiology Reference Article | Radiopaedia.org".
  6. ↑ Bouzas, Beatriz; Kilner, Philip J.; Gatzoulis, Michael A. (2005). "Pulmonary regurgitation: not a benign lesion". European Heart Journal. 26 (5): 433–439. doi:10.1093/eurheartj/ehi091. ISSN 0195-668X.
  7. ↑ Hiader EA. The boot-shaped heart sign. Radiology, 2008; 246 (1):328-9.
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