Right heart failure chest x ray

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Jad Z Al Danaf; Rim Halaby

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Overview

The plain chest radiograph has limited utility in identifying right heart failure. It might show evidence of the underlying cause of right heart failure like pulmonary embolism or congenital heart diseases.

Chest X Ray

The plain chest X-ray has limited utility in identifying right ventricular failure. However, some signs of pulmonary embolism can be evident on the chest X-ray such as: dilation of the pulmonary artery proximal to an embolism with collapse of distal vessels also known as oligemia (Westermark sign), distended azygous vein and a right sided heart enlargement/narrowed retrosternal space on lateral view ^[1].
In some cases, a chest X-ray might reveal a mediastinal mass that is impinging over the right side of the heart, which is better assessed with CT scan or an MRI.
Some radiographic findings can be seen in the setting of congenital heart diseases such as the “egg on a string” shaped heart in transposition of great vessels and the “boot shaped” heart in tetralogy of Fallot ^[2]^[3].

References

↑ Kevin L. and Barnard M. 2007. Right ventricular failure: Continuing education in anesthesia, critical care and pain. The Board of Management and Trustees of the British Journal of Anesthesia. 7(3).
↑ Hiader EA. The boot-shaped heart sign. Radiology, 2008; 246 (1):328-9.
↑ Feruson E.C., Krishnamurthy R. and Oldham S.A.A. Classic Imaging signs of congenital cardiovascular abnormalities. RadioGraphics, 2007; 27, 1323-1334.

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[1] Kevin L. and Barnard M. 2007. Right ventricular failure: Continuing education in anesthesia, critical care and pain. The Board of Management and Trustees of the British Journal of Anesthesia. 7(3).

[2] Hiader EA. The boot-shaped heart sign. Radiology, 2008; 246 (1):328-9.

[3] Feruson E.C., Krishnamurthy R. and Oldham S.A.A. Classic Imaging signs of congenital cardiovascular abnormalities. RadioGraphics, 2007; 27, 1323-1334.

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