Atrial septal defect chest x ray
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Priyamvada Singh, M.B.B.S. [2]; Cafer Zorkun, M.D., Ph.D. [3]; Assistant Editor(s)-In-Chief: Kristin Feeney, B.S. [4]
Overview
Chest x rays may be used as a diagnostic tool in the evaluation of an atrial septal defect. As a modality, chest x rays can be limited in diagnostic imaging quality and may often be elected to be used in conjunction with other imaging techniques. The chest x-ray may show right ventricular and right atrial enlargement, a prominent pulmonary artery segment, and increased pulmonary vascularity.
Common Findings
- In an anteroposterior view, one may see:
- Prominent pulmonary vascular markings on the chest[1]
- Enlargement of the cardiac silhouette[1]
- Normal apperance of the left atrium and left ventricle
- Triangular appearance of the heart
- Results from enlargement of pulmonary arteries preventing the ascending and transverse aorta from forming normal heart borders
- Visible fullness of the right atrium, likely the result of a moderate to large defect
- Scimitar sign, a vertical, modestly curved, density in the right-side of the pericardium, may be visible
- Commonly associated with the sinus venosus atrial septal defect
- Results from the point of insertion of the pulmonary vein into the inferior vena cava
- May cause abnormal densities within the chest x ray
- In a lateral view, one may see:
- Prominent pulmonary vasculature[1]
- Extends to the periphery of the lung fields and pulmonary trunk
- Central branches may be dilated
- Commonly found in ostium secundum atrial septal defects
- Both views may show pulmonary hyperemia
Less Common Findings
- Normal appearance of heart vasculature
- Left heart enlargement/left atrial enlargement
- Pulmonary edema
- Pulmonary venous hypertension
Disadvantages
- Image quality is not comparable to that of other modalities such as echocardiography and ultrasound
- Appearance of defect signs may be subtle or absent in pediatrics and young adults
Imaging
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Enlarged right atrial border and mild cardiomegaly.
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Lateral view
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Post repair. Enlarged right atrial border and mild cardiomegaly.
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Post repair. Lateral view.
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ASD. Another patient. Enlarged right atrial border and advanced cardiomegaly.
