RADIOLOGY OF THE

HEART AND GREAT

VESSELS



William H. Adams DVM
Associate Professor, Radiology
College of Veterinary Medicine
University of Tennessee

NORMAL ANATOMY -

THE HEART
Cardiac Silhouette
Delineates external margins of heart/ pericardium
Unable to define internal features of cardiac chambers
Unable to determine wall thickness or chamber size
Unable to delineate valvular morphology
Normal Variants
Feline cardiac silhouette consistent
Canine cardiac silhouette varies widely
breed
size
body type

Normal Feline
Lateral Projection
2 to 2.5 ICS wide
2/3 DV thoracic
diameter
Trachea deviates from
spine
Normal Feline
VD/DV Projection
Apex slightly to left of
midline
Broad convexity in area
of right atrium and left
ventricle
Flat left auricle area
Normal Canine
Deep-chested conformation
Doberman, Collie
Lateral projection:
Upright orientation -
perpendicular to spine
2/3 DV diameter
2.5 intercostal spaces
Trachea deviates from spine
Normal Canine
Deep-chested
Doberman, Collie
VD/DV projection
circular to ovoid heart
apex median to slightly left of
midline
Normal Canine
Intermediate
German Shepherd Dog
Labrador Retriever
Lateral projection
3 intercostal spaces
base angled craniodorsally
2/3 DV diameter
tracheal deviates from spine
Normal Canine
Intermediate conformation
German Shepherd Dog Labrador
Retriever
VD/DV projection
more elongated
apex to left
Normal Canine
Shallow-chested
Boston terrier, Bulldog
Lateral projection
heart shorter, more round
2/3 or greater DV diameter
3 to 3.5 intercostal spaces
tracheal deviation - less
greater "sternal contact"
(unreliable sign)
Normal Canine
Shallow Conformation
Boston terrier, Bulldog
VD/DV projection
short distance from thoracic
inlet to cupola of diaphragm
heart round to elongated
apex shift to left
EVALUATION

OF THE

CARDIAC

SILHOUETTE
VD / DV
Clockface Analogy
11:00 - 1:00 =Aortic Arch
1:00 - 2:00 =Main PA
2:30 - 3:00 =Left Auricle
2:00 - 5:00 =Left Ventricle
5:00 - 9:00 =Right Ventricle
9:00 - 11:00 =Right Atrium
Tracheal Bifurcation = Left
Atrium
AA
PAS
LAu
RV
LV
RA
LA
Lateral
Cranial border
Dorsal 1/3 (cranial waist)
right auricle
ascending aortic arch
main pulmonary artery
Ventral 2/3
wall of RV
pulmonary outflow tract
Lateral
Caudal border
Caudal waist
Left atrium
Left ventricle
Angiocardiography
Chamber size
Wall thickness
Valvular
conformation
Transit time
Angiocardiography
Non-selective
Contrast injection in peripheral vein
Selective
Catheter placement in area of interest
Fluoroscopy
cardiac chamber
vessel
Non-selective Angiogram
Indications
Valvular stenoses
Right to left shunts
Assess chamber size and wall
thickness
Pericardial effusion
Cardiomegaly
Most consistent indicator of heart disease
Wide range of normal
Mensuration techniques of questionable value
Diagnosis more secure as severity of changes
increases
Left Atrial Enlargement (LAE)
Dorsal displacement
of main stem bronchi
Convexity of caudal
waist
Increased size of
caudodorsal border
Left Atrial Enlargement (LAE)
Double opacity sign
Separation of main stem
bronchi
"Bow-legged cowboy"
Left auricular
enlargement (LAuE)
Left Ventricular Enlargement (LVE)
Dorsal displacement of the
trachea
Increase in proportion of
DV diameter of thorax
Straightening of caudal
border
Left Ventricular Enlargement (LVE)
Elongation of cardiac
silhouette
Deviation of cardiac apex
to left
Increased prominence in
2:00 - 5:00 region
Right Atrial Enlargement (RAE)
Lateral view
Dorsal Bowing of trachea
cranial to carina (J-shape)
Convexity of cranial waist
Right Atrial Enlargement (RAE)
VD/DV view
Increased
prominence in 9:00 -
11:00 region
Right Ventricular Enlargement (RVE)
Lateral view
Increased width of
the cardiac
silhouette
Increased
convexity of
cranial margin
Tracheal changes
as in RAE
Right Ventricular Enlargement (RVE)
VD/DV View
Increased
prominence in 5:00
- 9:00 region
"Reverse D" shape
Generalized Cardiomegaly
Combination of Roentgen signs involving both
left and right cardiac chambers
Microcardia
Cardiac silhouette < 2 1/2 intercostal spaces
wide
Supporting Roentgen signs
Pulmonary hypoperfusion
Consistently small caudal vena cava
Ddx: dehydration, shock, hypoadrenocorticism
Microcardia
Microcardia
NORMAL ANATOMY -

The Great Vessels
Caudal Vena Cava
Normal - approximately same as aorta
Variable with cardiac cycle, respiration
Small - hypovolemia/shock
Enlarged - congestive right heart failure
Aorta
Generalized enlargement
Segmental enlargements
Aortic arch - 11:00 - 1:00 (VD, DV)
Proximal descending aorta (ductus
arteriosus)
Main Pulmonary Artery Segment
(PAS)
1:00 - 2:00 region (VD, DV)
Associations
Pulmonary hypertension
Pulmonary outflow tract stenosis
DISEASES OF THE HEART

AND GREAT VESSELS
CONGESTIVE HEART FAILURE -

RADIOGRAPHIC DIAGNOSIS
Left Heart Failure
Definition: Inability of the heart to adequately
handle volume of blood returning from pulmonary
circulation
Pulmonary Venous Congestion
veins > arteries
Pulmonary Edema
caudodorsal / perihylar pulmonary infiltrate
interstitial >>> alveolar
Left-sided or Generalized Cardiomegaly

Left Heart Failure
Veins > arteries
Caudodorsal
Pulmonary infiltrate
nonstructured
interstitial
peribronchial
alveolar

Right Heart Failure
Definition: Inability of the heart to adequately
handle volume of blood returning from systemic
circulation
Systemic Venous Congestion
Enlargement of caudal vena cava
Visceral Congestion
Generalized hepatomegaly
3rd space fluid transudation
Canine - ascites predominates
Feline - pleural effusion predominates





CONGENITAL HEART

DISEASES
Congenital Heart Diseases
Pulmonic stenosis
Aortic stenosis
Patent ductus arteriosus
Tetrology of Fallot
Pulmonic Valvular Stenosis (PS)
Valvular > subvalvular >>
supravalvular
Right heart enlargement
(RVE +/- RAE)
Main Pulmonary Artery Segment
(PAS) enlargement
Normal to small pulmonary vessels
Right heart failure
PULMONIC STENOSIS
Aortic Valvular Stenosis (AS)
Subvalvular lesion
LVE, +\- LAE
Elongation of the cardiac
silhouette
Bulge in 3:00 5:00 area
Increased prominence of
aortic arch
Bulge in cranial waist
(lateral)
Widening of 11:00 - 1:00
area (VD/DV)
Radiographs may be
normal

AORTIC STENOSIS
Patent Ductus Arteriosus (PDA)
Shunt from aorta to PA
LVE, LAE, LAuE
Aneurysmal dilatation of
proximal descending aorta
PAS enlargement
Normal to large pulmonary
vessels
Left heart failure
PATENT DUCTUS ARTERIOSUS
Tetralogy of Fallot
Pulmonic Stenosis
High VSD
Overriding Aorta
Right Ventricular
Hypertropy
Overriding
aorta
PS
VSD
RVH
Tetralogy of Fallot
RVE
Boot-shaped heart (cor
sabot)
Main PAS variably
enlarged
Small pulmonary
vessels
TETROLOGY OF FALLOT
COR SABOT
ACQUIRED HEART DISEASE
Heartworm Disease
Pulmonary arterial
changes
RVE, RAE
Enlarged PAS
Pulmonary infiltrates
PIE - like
PTE
Right heart failure
CANINE HEARTWORM
DISEASE
Feline Heartworm Disease
Endocardiosis
Atrioventricular (AV) valvular insufficiency
Left AV (mitral) valve - (MI)
Right AV (tricuspid) valve - (TI)
Right and Left AV valves (MI/TI)
Endocardiosis
Mitral Insufficiency (MI)
LAE, LVE
Left heart failure
Tricuspid Insufficiency (TI)
RAE, RVE
Right heart failure
Right and Left AV Valves (MI/TI)
Generalized cardiomegaly
Right and/or left CHF
Mitral and Tricuspid Insufficiency
Canine Dilated Cardiomyopathy
Generalized cardiomegaly
typically left side predominant
LAE and LAuE
Left, right or biventricular heart failure
Dilated Cardiomyopathy
with left heart failure
Feline Cardiomyopathy
Both dilated and hypertrophic forms
Cannot be definitively distinguished on survey
radiographs
Non-selective angiocardiography
Echocardiography
Feline Dilated Cardiomyopathy
Generalized Cardiomegaly
Heart failure
right predominant
pleural effusion
hepatomegaly
biventricular
Feline Dilated Cardiomyopathy
with right heart failure
Feline Hypertrophic
Cardiomyopathy
Left cardiomegaly predominant
"Valentine-shaped" heart
LAE, RAE
+/- ventricular enlargement
Heart failure
Left CHF predominant
+/- Right CHF (pleural effusion)
Feline Hypertrophic Cardiomyopathy
DISEASES OF THE

PERICARDIUM
Pericardial Effusion
Spherically enlarged, globoid cardiac silhouette
Lack of discreet chamber definition
Differentiate from generalized cardiomegaly
Right heart failure
Additional imaging
US
nonselective angiogram
Pericardial Effusion
Peritoneal-Pericardial
Diaphragmatic Hernia
Gas-containing bowel loops
Silhouette heart / cupola of diaphragm
"small liver
Sternal deformity
Additional Imaging
Ultrasound
Contrast Studies
Upper GI
Pneumoperitoneum

Peritoneal - Pericardial
Diaphragmatic Hernia