Pulmonic regurgitation Chest X-Ray

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], Javaria Anwer M.D.[4]

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 among patients with concomitant tricuspid regurgitation. On plain chest X ray PR may be characterized by right ventricular enlargement, prominent pulmonary trunk, features of tricuspid regurgitation (TR), and of congestive heart failure (CHF).

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 ventricular enlargement. Right atrial enlargement may also be seen among patients with concomitant tricuspid regurgitation.
• On plain chest X ray PR may be characterized by:
  1. Right ventricular enlargement (specially among patients with surgical repair of TOF)
  2. Prominent pulmonary trunk
  3. Features of tricuspid regurgitation (TR) may also be present. To read more about CXR findings associated with TR, click here.
  4. Features of congestive heart failure (CHF) may also be present. To read more about CXR findings associated with CHF, click here.

Right ventricular enlargement:

• Progressive right ventricular enlargement is common among patients with PR after TOF repair.
• On CXR, right heart failure (RHF) is chracterised by right ventricular enlargement.
  • Right ventricular enlargement on PA view demonstrates rounded left heart border and uplifted cardiac apex.
  • On lateral view, filling of the retrosternal space and rotation of the heart posteriorly. CXR has limited utility in the diagnosis of RHF.

Tetralogy of Fallot (TOF)

• On CXR of a patient with PR as a complication of tetrology of Fallot (TOF) repair, a “boot shaped” heart may be demonstrated.

Prominent pulmonary trunk

• On CXR of a patient with PR secondary to pulmonary hypertension (PAH) or idiopathic dilatation of pulmonary artery (IDPA), featurs demonstrating PAH may include prominent pulmonary trunk and broadened mediastinum.
• It is also important to note that IDPA is a diagnosis of exclusion and pulmonary artery/ pulmonary trunk may appear prominent in the chest X ray of young patients, especially women or in a chest X ray AP/lordotic view.

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

Chest X ray PA view demonstrating pulmonary artery hypertension. An enlarged cardiac silhouette with prominent pulmonary trunk and pulmonary arteries proximally is also demonstrated - Case courtesy of Assoc Prof Frank Gaillard, Radiopaedia.org, rID: 8653