LINES, TUBES, WIRES in the cardiac patient: an imaging puzzle

Congress:

ESCR 2014

Poster Number:

464

Type:

Scientific Poster

Keywords:

Thorax, Cardiovascular system, Conventional radiography, Digital radiography, CT, Diagnostic procedure, Education and training

Authors:

S. Kampanarou¹, S. Katsilouli², O. Karapanagiotou², T. Syrigou², N. Kollaros³, T. Mpagiatis², I. Mastorakou²; ¹Nikea/GR, ²Athens/GR, ³Kallithea/GR

DOI:

DOI-Link:

https://dx.doi.org/

Fig. 1: Most of the times, the lines and tubes in ICU CXRs look like a maze.

Fig. 2: A 2D image of a 3D world can be astonishing sometimes

Fig. 3: A schematic presentation of the valve topography at the coronal level

Fig. 4: The CXR PA view of a patient with replacement of all three valves: Both the...

Purpose

Various types of catheters, tubes and support equipment are used during treatment of patients with cardiac disease. In addition, hospitalized patients may need support in other than the cardiac systems.Proper placement of all these devices is mandatory in order to monitor and support cardiac function. Thus, imaging of these patients plays a key role in patients' treatment and all rasdiologists have to be familiar with the devices used, their use, the right positioning and the complications caused by malpositioning. Supporting systems that will be introduced...

Methods and Materials

During the past twenty two years a population of nearly 11,000 patients have been hospitalized in the Intensive Care Units (ITUs) of our institution- a tertiary health care centre, national reference centre for cardiac disease. All these patients have had several CXRs, usually from a portable X-Ray system. In addition, many of them have had examinations with Computed Tomography (CT) scanners for various reasons. The X-Ray systems used all these years range from fully analogue to fully digitized. The CT systems used were a spiral...

Results

A. CARDIOVASCULAR SUPPORT 1. PROSTHETIC VALVES a. SURGICAL REPLACEMENT The introduction of valve replacement surgery in the early 1960s has dramatically improved the outcome of patients with valvular heart disease. Approximately 90 000 valve substitutes are now implanted in the United States and 280 000 worldwide each year; approximately half are mechanical valves and half are bioprosthetic valves. REF Recognizing the prosthetic valves in CXR is an easy task most of the times. The reference point is the aortic root in both posterio-anterior and lateral...

Conclusion

Interpretation of CXR in ICU patients may sometimes turn into a difficult puzzle, only because of the presence of various supporting devices. In this pictorial review, we have tried to introduce as many as we could step-by-step. We hope it can be used as an initial navigator through this maze of tubes, lines and wires - together, of course, with continuous and further reading on ever-developing technology.

References

FURTHER READING CB HIGGINS : ESSENTIALS OF CARDIAC RADIOLOGY AND IMAGING by JB LIPPINCOTT COMPANY GOODMAN & PUTMAN : CRITICAL CARE IMAGING by WB SAUNDERS COMPANY P. Pivarot, J. Dimesnil : Valvular Heart Disease: Changing concepts in Valve Disease managementCirculation.2009;119:1034-1048 PTL Chiam, CE Ruiz : Percutaneous Transcatheter Mitral Valve Repair : A classification of the technology Am Coll Cardiol Intv. 2011;4(1):1-13 Cao C, Ang SC, Indraratna P, Manganas C, Bannon P, Black D, Tian D, Yan TD. Systematic review and meta-analysis of transcatheter aortic valve...