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As discussed in other chapters in this text (see Chaps. 18, 19, 20, 21, 22, 23, 24, 25), the relatively low-cost chest radiograph is less commonly used as a primary diagnostic technique for determining the presence and severity of cardiac disease even when it provides diagnostic information (eg, pulmonary venous hypertension).

With the development of many new cardiac imaging techniques, familiarity with the altered anatomy and understanding of the underlying pathophysiology of a diseased heart are the cornerstones to appropriate interpretation of its radiographic manifestations. The conventional four-view cardiac series is tabulated in Table 17–1 and the views are illustrated in Fig.17–1C–F.

TABLE 17–1. Conventional Four-View Cardiac Series

Practical application of four-view cardiac series. A. Posteroanterior (PA) view in a patient with coarctation of the aorta showing areas of rib notching bilaterally and left ventricular (LV) enlargement in the inferior and leftward direction. B. Magnified view of the left upper thorax of the same patient showing multiple areas of rib notching (arrows). C. PA view of another patient with aortic coarctation showing the 3 sign of the deformed descending aorta and E sign on the barium-filled esophagus. The upper arrow points to the level of coarctation, and the lower arrow marks the apex of the enlarged LV. The arrow on the patient's right indicates the dilated ascending aorta. D. Lateral view of a third patient with the same disease showing a barium-filled esophagus to be pushed forward (upper arrow) by the poststenotic dilatation of the descending aorta and pushed backward (middle arrow) by the enlarged left atrium (LA). The very large LV (lower arrow) simply casts a shadow behind the esophagus without displacing it. The oblique arrow points to the calcified stenotic bicuspid aortic valve. E. Right anterior oblique view of the same patient whose PA view is shown in Fig. 17–7D. Note the huge right atrium (RA) casting a triangular density (lower horizontal arrow) behind the esophagus without displacing it. The esophagus is deviated posteriorly by the enlarged LA (upper horizontal arrow). The upper oblique arrows indicate the direction of ...

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