State University of Medicine and Pharmacy Nicolae

Testemițanu

DEPARTMENT OF RADIOLOGY AND

IMAGING

Pathological cardiac configurations

SUBMITTED BY:MURUGAN RAJASREE AJAYALAL

GROUP:M1961
DATE:29/10/2021
Normal configuration of the heart
Defining configurations of heart
Right contour:
2nd intercostal space along right sternal edge
3rd intercostal space along right sternal edge
4th intercostal space 1 cm laterally of right sternal
edge
Left contour:
2nd intercostal space along left sternal
edge
3rd intercostal space along left
parasternal line
4th and 5th intercostal spaces 1,5 cm
medially of left midclavicular line.
Normal configuration
 The arc of the right contour of the heart include–vena cava superior– on the edge of the
sternum to R. III, right atrium in the 3-4 intercostal spaces 1 cm outwards from the right
edge of the sternum.
 The angles of the right contour of the heart in norm –
 1) angle between vena cava superior and right atrium
 2)right atrium and diaphragm in the 5 intercostal space from the sternum
 The arc of the left contour of the heart in norm - I intercostal space at the edge of the
sternum - aortic arch, II intercostal space at the sternum – the arc of the pulmonary artery,
level III R. over the edge of the sternum arc of the left atrium, below the arc of the left
ventricle.

 The "waist" of the heart is the angle between the vascular bundle and the arc of the left
ventricle. In normal configuration of the heart this angle exceeds 90°
Pathological cardiac configuration
The normal cardiac configurations aspects, together
with the normal position of the landmarks of the
cord position and dimensions indicated above.but In
different pathological processes,other than normal
configuration ,different pathological configurations
can be formed such as mitral, aortic, and trapezoid
configurations of the heart can be observed

Frontal chest radiograph shows evidence of

bronchial wall thickening (arrows) and
hyperinflation, with more than six anterior ribs
identified
Mitral configuration
 protrusion of the upper part of the left contour,
 indistinct or protruded waist of the heart due to
dilation of the left atrium and pulmonary
hypertension.
 It Can be observed in mitral heart disease (mitral
regurgitation, late stages of mitral stenosis)

heart with an increase in the left

atrium. The arcs of the left atrium (arrow) and
pulmonary artery(short arrow) are enlarged.
On the right, in the background of the right
atrium shade, the shade of the left atrium
Aortic configuration.
 protrusion of the lower part of the left
contour,pronounced waist of the heart
due to significant dilation of the left
ventricle.
 It Can be observed in aortic defects
(stenosis, regurgitation) and
hypertension

an increase in the left ventricle.

Direct projection. The LV border extends beyond the
left
median-clavicular line, the cardio-thoracic index
exceeds
50%. The top of the ventricle is expanded, rounded
Trapezoidal configuration
 has the shape of a trapeze with a wide base at
the bottom with a gradual narrowing upwards.
 It is Observed in pericardial effusion, with
accumulation of significant amounts of
transudate or exudate in the pericardial cavity.

"Trapezoid" configuration of the shadow of

the heart:
cardiomegaly in severe heart failure. The
shadow of the
heart is expanded in both directions
Spherical configuration of the heart
 when the ventricular septal defect
due to the discharge of blood from
the left to the right ventricle

congenital heart defect. ventricular septal defect (direct view): the

shadow of the heart increased at the expense of both ventricles,
visible bulging arc pulmonary trunk (arrow), pulmonary picture in
the basal parts of the lungs are strengthened.
Conclusion
 Cardiac configuration refers to the outline of the heart as seen on frontal and lateral chest
radiographs and forms part of the cardiomediastinal contour. The size and shape of the
cardiac silhouette provide useful clues for underlying disease.
 In pathological conditions, mitral, aortic, and trapezoid,cor bovinum etc.configurations of the
heart can be observed.
 Now on next, my collegue will explain you about the basic pathological process which will
lead to the above mentioned pathological conditions.