Human Anatomy: Part 2 - K. A. Dyubenko, A. K. Kolomiyytsev, Yu. B. Chaykovsky 2008

Special Part
Cardiovascular system, systema cardiovasculare - Special Part
Heart - X-ray anatomy of the heart

Radiological examination is used to study The Heart contours, its anatomical parts, shape, border positions, dimensions, and The Nature of movements of its individual chambers. From an X-ray anatomical perspective, three main positions of the heart in the thoracic cavity are distinguished: vertical, oblique (most common), and horizontal (Fig. 11 A, B, C, D).

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Fig. 8. The heart, posterior view (inferior diaphragmatic surface) after R. D. Sinelnikov

Fig. 9. The heart, anterior view (anterior sternocostal surface) after R. D. Sinelnikov

In the oblique position of the heart, the angle of inclination of its longitudinal axis to the horizontal is 43–48°. In individuals with a normosthenic constitution, the major part of the heart is located to the left of the midline.

The vertical position of the heart is observed in individuals with an asthenic constitution; the angle of inclination of its longitudinal axis is 49–56°, with the line drawn through the spinous processes of the vertebrae seemingly dividing the heart in half. The horizontal position of the heart occurs in individuals with short and broad chests. In this case, the angle of inclination of the organ is 35–42° in individuals with a hypersthenic constitution; the greater part of the heart is situated to the left of the midline and closely abuts the dome of the Diaphragm.

Fig. 10. PROJECTION OF THE heart borders and Auscultation sites of the heart Valves.

1 - mitral valve; 2 - tricuspid valve; 3 - aortic valve; 4 - pulmonary trunk valve

The primary projection in X-ray anatomical studies is the anteroposterior (straight) projection. In this position, four arches are visible along the left contour, and two along the right (Fig. 11 A). The first arch on the left is formed by the aorta, the second by the pulmonary trunk and partially the left pulmonary artery, the third by the left auricle, and the fourth by the left ventricle. On the right, the vascular arch is formed by the ascending aorta, and the cardiac arch by the right atrium. Most of the anterior surface of the heart is occupied by the right ventricle. The Base of the ventricle corresponds to the coronary sulcus, which runs across the anterior surface of the heart. The right atrioventricular (tricuspid) valve is located in this plane. Closer to the lower part of the base of the conus arteriosus lies the mitral (bicuspid) valve.

Fig. 11. Diagrams of the X-ray image of The Heart and great vessels in the anteroposterior (a), right (first) oblique (b), left (second) oblique (c), and left lateral projections (d).

1 - Vertebral Column; 2 - retrocardiac space; 3 - aortic window; 4 - retrosternal space; 5 - aortic arch; 6 - ascending aorta; 7 - SUPERIOR VENA CAVA; 8 - pulmonary trunk; 9 - pulmonary conus; 10 - left atrium; 11 - right atrium; 12 - right ventricle; 13 - left ventricle; 14 - descending aorta. Bold lines indicate the heart contours; dashed lines indicate the borders between chambers; the arrow indicates the cardiac waist.

In the right oblique projection (Fig. 11 B), the contour of the shadow of the heart and great vessels is formed by four arches: the ascending aorta, the pulmonary trunk, the outflow tract of the right ventricle, and the outline of the left ventricle. The posterior contour is formed by the superior vena cava, the left atrium, and the right atrium. The posterior contour of the heart is demarcated from THE VERTEBRAL COLUMN by a radiolucent strip known as the retrocardiac space.

In the left oblique projection (Fig. 11 C), the anterior contour of the heart is formed superiorly by the ascending aorta and the right atrial auricle, and inferiorly by the right ventricle. The upper arch along the posterior contour of the heart is formed by the left atrium, and the lower arch by the left ventricle. A radiolucent strip, the retrocardiac space, is located between the posterior contour of the heart and the vertebral column. The ascending part, arch, and descending part of the aorta seemingly outline a radiolucent space known as the aortic window.

In the left lateral projection (Fig. 11 D), the anterior contour of the heart is formed by three arches: the ascending aorta, the pulmonary trunk, the conus arteriosus of the right ventricle, and the right ventricle itself. A narrow radiolucent strip, the retrosternal space, lies between the Sternum and the right ventricle. The posterior contour is formed by arches: the upper one (left atrium, right atrium) and the lower one, which is formed by the left ventricle.