RadiodiagnosisintheCirculatorySystem循環系統X線診斷貴州省人民醫院放射科唐雷Section1TheHeart1.TypesofHeartinthePlainFilmsInthenormalcondition,aheartoftenappearsinthehorizontal（橫型）,oblique（斜型）,andpendulous（懸垂型）typerespectivelyonaposteroanteriorradiographoftheheart.Theangleofthecardiacaxis（心軸角）:itisanacuteangleformedbyalinefromtheconjunctionofthegreatvessulesoftherightcardiacborderandtherightatrium（心房）

tothecardiacapex（心尖）

andahorizontallinewhichpassesthroughthecardiacapex.心軸角：右心緣大血管與右房交界點至心尖的連線，與水平線的夾角。Thehorizontaltype（橫型）<45°(32°~35°)Theobliquetype（斜型）=45°(43°~45°)Thependuloustype（懸垂型）>45°(52°~55°)ThreetypesoftheheartintheplainfilmInthepathologicalstates,theheartcanbedeformedinthemitral（二尖瓣型）,aortic（主動脈型）,andgeneralenlarged（普大型）typeseparately.Atypeoftheheartcanderivefromseveralheartdiseases.Forexample,Themitraltypeoftheheartmayoriginatefrompulmonaryheartdiseases,rheumaticheartdiseases,congenitalheartdiseasesofshuntfromlefttoright.Theaortictypeoftheheartmaycomefromhypertensiveheartdiseases,rheumaticheartdiseases(involingaorticvalves),congenitalheartdiseases,cardiomyopathy.Thegeneralenlargedtypeoftheheartmaycomefromcardiomyopathy,pericardialeffusion.2.DifferentroutineprojectionsofthecardiacatriaandventriclesPA:posteroanteriorradiograph（后前位）LL:leftlateralradiograph（左側位）RAO:rightanteriorobliqueradiograph（右前斜位）LAO:leftanteriorobliqueradiograph（左前斜位）PA:posteroanteriorradiograph（后前位）LL:leftlateralradiograph（左側位）RAO:rightanteriorobliqueradiograph（右前斜位）cardiacatriaaredistinguishedfromcardiacventricles.Twocardiacatrialocateintheposteriorsuperiorpartoftheheartandtwocardiacventriclesoverlapandsettledownintheanteriorinferiorpartoftheheart.LAO:leftanteriorobliqueradiograph（左前斜位）theshadowoftheheartisdividedintotwohalvesoftherightheartandleftone.Therightonestaysinthefrontandtheleftonerestsontheback.3.Thecardiothoracicratio(心胸比率)Calculationofthecardiothoracicratiohasbeenthesimplestandmostfrequentlyusedmethodformeasurementoftheheart.Thecardiothoracicratio=(A+B)/CTheratioisdefinedasthevalueofthetransversedimensionoftheheartdividedbytheinnnerdimensionofthethoraciccavityatthelevelofcrossingthedomeoftherighthemidiaphragm.Relationbetweensizeoftheheartandthecardiothracicratio:Normalheartlessthan0.52Slightenlargement0.52~0.55Moderateenlargement0.56~0.60Severeenlargementmorethan0.604.ChangesofpulmonarybloodPulmonaryarterialpleonaemia(肺充血)：meansthatpulmonaryarterieshavebeenbroadenedinallitstrunksandbranches.

Pulmonaryvenouspleonaemia(肺淤血)：referstothesituationthatexcessivebloodstagnatesinthepulmonaryveins.So,thelungfieldshaveanattenuatedradiolucencyandseemlikegroundglass.5.Pulmonaryedema(肺水腫)Ininterstitialedema(間質性肺水腫)，bothpulmonaryhilaexhibitenlargementandhazyshadows.Thelungmarkingsappearabundantwithfuzzymargins.Theseblurtheborderoftheheartassociatedwithdilationofbilateralupperpulmonaryveins.Inalveolaredema(肺泡性肺水腫)，therearelargepatchyopacitiessurroundingthepulmonaryhilaintheshapeofabutterfly.Theshadowsofthearchesfadeoutintheheart.CasesintheHeartCase1.正常心臟三位片Thethoraciccageremainssymmetrical.Alltheseenbonesarenothingremarkable.Thetrachealocatescentrallywithoutdeviation.Thelungsareclear,whilethelungmarkingsarenaturalandregular.Bothpulmonaryhilashowneitherenlargementnordecrease.Theheartandgreatvesselsappearnormalintheirposition,sizeandshape.Thecardiothoracicratiois0.48,andalltheshadowsofthearchesshownaturallyinthemarginsoftheheart.Thediaphragmhasasmoothsurfacewithsharpcostophrenicangles.OntheLLradiograph,thespacesexistintheprecardiacandretrocardiacclearances.Thereisnosignificantchangeintheshadowsofthearchesoftheheart.OntheRAOradiograph,alltheshadowsofthearchesappearclearandnatureintheheart.Thereisnocompressivedisplacementintheesophagus.Nothingisremarkableintheprecardiacandretrocardiacapaces.Diagnosis:Normalinthelungs,heart,anddiaphragm.Case1.正常心臟三位片Case2.風濕性心臟病Thelungfieldshaveanattenuatedradiolucency.Thelungmarkingsexhibitthickeningsanddistortionswithblurrededgesandseemlikegroundglass.Bothpulmonaryhilaareenlarged,andthediameteroftherightinferiorartery（右下肺動脈）totals1.8cmwiththesignofresidualroot（殘根征）.Theheartappearsinthemitraltype（二尖瓣型）.Theshadowoftheheartextendsonbothsidesinthecardiothroacicratioof0.65.Thereare4archesintheleftmargin（四弧征）,whiledualbows（雙房影）intherightmarginoftheheart.Theangleisalmost90°betweenthetwomainbronchi.OntheLLradiograph,theclearancesareclosedinbothprecardiacandretrocardiacspacesduetoenlargementoftheheart.Theenlargedleftatriumcompressestheesophagustoformanindentation.OntheRAOview,theprecardiacandretrocardiacspacesareenclosed.Theenlargedheartpushestheesophagusbackward,forminganarchindentationintheesophagusandoverlapswiththespinalcolumn.Meanwhile,thesegmentofthepulmonaryarterybulgessignificantly.

Diagnosis:Rheumaticheartdisease.FurtherexaminationisneededbyheartDopplerul