Cor Pulmonale

FIGURE 1.3. Ventilation-perfusion imaging in diagnosis of pulmonary embolism. A:Ventilation image, obtained with 99mTc pentetate aerosol, shows homogenous ventilation on posterior view. B: Matched perfusion image shows large (segmental) perfusion defects in the left mid lung, and in the lateral segment of the left lower lobe. There is also decreased perfusion in the right upper lobe. The presence of unmatched segmental abnormalities indicates a high probability for pulmonary embolism.

FIGURE 1.32. A 60-year-old man with pulmonary hypertension due to chronic liver disease. A: On the frontal chest radiograph, the main pulmonary artery is enlarged (arrow). The right interlobar pulmonary artery is enlarged, measuring 20 mm. The normal value is 17 mm (arrows). B: On the lateral view, the left pulmonary artery is enlarged, measuring 23 mm, compared with a normal value of 20 mm.

FIGURE 36.2. Bilateral pulmonary embolism (arrows) demonstrated by contrast-enhanced spiral computed tomography scan.

FIGURE 82.1. Chest radiograph of older child with congestive heart failure. Note cardiac enlargement and evidence of pulmonary venous congestion.

<bold>Figure 13.5</bold> Contrast enhanced multirow (16-slice) detector chest CT in a patient with acute pulmonary embolism. In the coronal reconstructed view, multiple segmental emboli can be visualized <italic>(arrows)</bold>. (Figure kindly provided by Joseph Schoepf, MD, Department of Radiology, Brigham and Women’s Hospital, Boston, MA.)

<bold>Figure 13.7</bold> Primary evidence of acute pulmonary embolism. Selective cut-film angiogram of the right lower lobe pulmonary artery with multiple intraluminal radiolucencies, almost completely outlined by contrast <bold>(left)</bold>. Corresponding segmental perfusion defects of the right lower lobe <bold>(right)</bold>.

<bold>Fig C 1-22 Pulmonary infarction.</bold> (A) Chest film made 3 days after open-heart surgery demonstrates a very irregular opacity at the right base (pneumonia versus pulmonary embolization with infarction). (B) On a film made 5 days later, the consolidation is seen to have reduced in size yet to have retained the same general configuration as on the initial view. The diagnosis of pulmonary embolism was confirmed by a radionuclide lung scan.⁵

<bold>Fig C 2-1 Congestive heart failure.</bold> Diffuse bilateral symmetric infiltration of the central portion of the lungs along with relative sparing of the periphery produces the butterfly, or bat's wing, pattern. The margins of the edematous lung are sharply defined. The consolidation is fairly homogeneous and is associated with a well-defined air bronchogram on both sides.⁶

<bold>Fig CA 13-3 Cor pulmonale</bold> (primary pulmonary hypertension). (A) Frontal and (B) lateral views of the chest show prominence of the pulmonary outflow tract and markedly dilated central pulmonary vessels. The lateral displacement of the cardiac apex and filling of the retrosternal air space indicate right ventricular enlargement.

<bold>Fig CA 13-3 Cor pulmonale</bold> (primary pulmonary hypertension). (A) Frontal and (B) lateral views of the chest show prominence of the pulmonary outflow tract and markedly dilated central pulmonary vessels. The lateral displacement of the cardiac apex and filling of the retrosternal air space indicate right ventricular enlargement.

<bold><italic>FIGURE 6.64.</bold></bold> Apical four-chamber view recorded in an elderly patient with long-standing mild systemic hypertension and congestive heart failure due to predominantly diastolic dysfunction. Note the evidence of significant atrial enlargement, which is a marker of long-standing diastolic dysfunction. LA, Left atrium; LV, left ventricle; RA, right atrium; RV, right ventricle

Echocardiography in a patient with massive pulmonary embolism. The right ventricle (RV) is markedly enlarged, flattening the intraventricular septum and compromising the left ventricle (LV).

<bold>Figure 1.25. Ventilation-perfusion scan in a patient with pulmonary emboli. A.</bold> Perfusion scan of the lungs shows many areas devoid of radioisotope (photopenia) bilaterally. <bold>B.</bold> The ventilation scan is normal. This combination of findings is diagnostic of pulmonary embolism.

<bold>Figure 4.27. Kerley lines in patients with congestive heart failure. A,</bold> AP radiograph shows prominent interstitial markings in both bases with a fine interlacing pattern. <bold>B,</bold> detail view shows the linear horizontal Kerley B-lines in the periphery. <bold>C</bold> and <bold>D,</bold> detail views of two other patients show similar findings.

PA chest x-ray showing lung hyperinflation in a patient with COPD

Lateral chest x-ray showing increased A-P diameter in a patient with COPD

<bold>Figure 5.33. Congestive heart failure and pulmonary edema. A.</bold> Frontal view shows mild pulmonary edema and pulmonary venous engorgement. <bold>B.</bold> Detail view shows the edema and prominent septal (Kerley) lines. <bold>C.</bold> Detail view in another patient shows the prominent horizontal Kerley lines.

<bold>FIGURE 11-27. Cor pulmonale.</bold> A transverse section of the heart from a patient with primary (idiopathic) pulmonary hypertension shows a markedly hypertrophied right ventricle (on the left). The right ventricular free wall has a thickness equal to the left ventricular wall. The right ventricle is dilated. The straightened interventricular septum has lost its normal curvature toward the left ventricle as part of the remodeling process in cor pulmonale.

CT scan showing pneumothorax in patient with COPD