Xray Evaluation Of Cardiac Size

1. How is determination of cardiac size by X-ray usually calculated?

ANS: By cardiothoracic (C/T) ratios. Fifty percent is considered by most radiologists to be the upper limit of normal.

2. How can we overcome the falsely normal C/T ratios in subjects who are short and underweight, or the falsely high C/T ratios in subjects who are overweight?

ANS: By the use of the height and weight tables of Ungerleider and Clark [4].

3. How can you measure cardiac volume to derive a more accurate cardiac size than by any other X-ray method?

ANS: The cardiac volume uses the lateral chest film and body surface area. The length dimension (L) is measured in centimeters from the junction of the superior vena cave and right atrium to the cardiac apex. The broad diameter (B) is measured from the junction of the right atrium and diaphragm to the junction of the pulmonary artery and left atrial appendage. The lateral dimension (D) is the greatest horizontal cardiac lateral diameter where BSA = body surface area. The 0.42 is the correction factor for a 6-ft distance of the heart from the film [5].

Instead of using the tables (see p. 102), one may use the formula

Weight x 25 = + 70 for males Height + 62 for females

The answer is in mm and 10% above the average may be normal or slightly enlarged. If kilos and mm are used, multiply the weight by 2.2 and divide the height by 2.5.

Cardiac volume =

PA view

Lateral view

The upper normal values are 490 (cm3) for females and 540 (cm3) for males.

PA view

Lateral view

The upper normal values are 490 (cm3) for females and 540 (cm3) for males.

Theoretical transverse diameters of heart Table for determining percent for various heights and weights deviation from average

Jf

MBtBfBlllBBtHIBIllB||miliHilBl^ ^QQQQ^ ÜBHHIBlIk

13 15

17 II

16 II

91 93 9$

91

101

100 102

(Light figures represent weights)

77 77 71

11 •3 >2 •3

16 17 II II

94

104

114

116 117 111 120

120 »21 122 124 >25

130

100 102 104

100 >02 104 106

101 103 105 107

>01 103 105 107 109

104 106 >01 110

10« 106 >01 110 112

106 101 no

1 14

i ii 113 115

117

79 10 10 11 12

16 16 17

93

104

114

116 >17 >11 >19 120

>21 122

131

101 110 113

106 101 no 112 114

101 109 111 113 115

111 113 115 117

111 113 115 117 119

113 115 117 119 121

114 1 16 111 121 123

116 111 120 123 135

126 121

121 123 125 121 130

>25 127 129 »32

139 131 133

133 >35

137

16

91

97

100 101 102 103

137

131 t39 »40 141 143

116 til 120

114 116 11* 120 123

116 11« 120 122 124

117 120 122 124 126

119 121 >24 126 131

121 123 125 121 130

131 134

127 129 131 133 136

131 133 I3S >31

130 133 135 137 140

132 134 137 139 142

134 »36 139 141 >43

136 131 141 143 145

19

100 101

106 107

no 111 112 >13

131

137

149

120 122 124 126 121

124 126 I» 130

124 126 ■ 31 130 133

126 121 130 132 134

137

141

134 136 131 141 (43

>31 140 143

147 149

151 153

151

150 157 155 157 160

152 >54 157 160 162

154 156 159 162 164

156 159 161 164 166

93

97 91 91 99

105 105

110 111 >12

116 117 111

120 121 122 121 124

136

141 143

154 »55

130 132 134 136 139

132 134 137 139 141

137 139 141 143

137 139 141 HI 146

150 152

145 141 150 152 155

157 159

157 159 162

>54 >56 159 161 164

156 159 161 164 166

151 »6» »63 166 »69

160 163 166 »61 171

163 165 161 171 173

171

172 175 177 >10

97

100 101 102 »02 103

106 107 101 109

Ito

115 1 16

120 121 127 173

135 126 127 121 129

134 >35

147 141

160 161

141 143 145 147 »50

153

141 150 157 153 157

150 152 155 157 160

152 155 157 160 162

155 157 160 162 164

157 160 162 165 167

173

177 179

171 >74 177 179 112

174 176 179 112 114

176 >79 HI 114

117

171 111 »14 117 119

111 113 116 >19 192

100 101

120 121

174 124 135 176 137

141

154

157 151 160 161

164 »65 166 161

152 154 156 159 161

157 159 161 164

157 159 162 164 166

159 162 164 167 169

162 164 167 169 172

172 174 177

172 175 177 110

172175 177 110 112

175 177 110 112 IIS

177 110 112 115 111

190 193

»17 190 !93 196

117 loo 193 196 >91

190 193 195

191 701

195 191 201 204

»95 191 201 204 206

104 104

125

131 133

1 3S 134 137 13« 139

146

160

164 166 167

174

163 166 161 170 173

166 161 171 173 176

171 174 176 »71

174 176 179 111

174 177 179 112 114

177 179 113 IM 117

110 112 115 117 190

190 193 196

190 193 196 199

190 193 196 199 201

707 704 707

199 201 204 207 310

201 204 207 210 213

704 207 210 213 216

207 210 213 216 319

209 212 216 219 222

212 215 211 221 224

130

137

142 14} 144

151

173

176 >71 179 110

175 171 110 »12 lis

194

191 200

30t 204 206

201 204 207 210

216

207 210 213 216 219

710 713 716 219 277

213 216 219 222

225

216 219 227 225 221

219 222 225 221 231

237

221 231 234 237 240

111 119

124 >25 »76 137

133 »34

141 143

145 144 147 14« 14»

176 171 179

116

117 190 192 195 >91

191 193 196 191 201

194 196 199 201 204

197 199 202 205 207

200 203 205 201 211

203 206 201 211 214

206 209 212 214 217

209 212 215 211 331

212 215 211 221 234

215 211 221 224 237

219 22? 224 22 7 230

722 225 221 231

234 237

247 250

740 744 747 750 253

243 247 250 253 257

113 113 1 t4 >15 116

131

137 131 139

146

153 114

160 161 162

166 167 161 169

177

115

119 190 »91 193

200

203 206

207 210

210 213 216

213 216 219

217 220 222 225

220 223 226 229

224 327 229 232 235

237 230 233 236 239

243 246

237 240 743 246 749

?40 243 246 249 253

243 347 250 353 256

347 750 753 256 260

250 254 J57 260 263

753 257 260 763 767

2J7 260 263 767 270

260 264 767 270 779

116 117 111 119 119

176 176 127

135

151

155 154 157 15« 159

166 167

175

171 179 1«! 113 113

196 191

199

34$

249

757 755 759

256 259 262

259 263 266 769 273

763 766 770 773 776

766 770 773 277 210

291 |

131

137 131 139 139

156

144

no

116 117 1«9

Actual Predicted Actual

Diameter (mm)

The heart is usually enlarged if the width is 10% greater than the average prediction, which is shown in the boldface vertical column on the right. Subtract 8 mm for women, since this table was derived from thousands of male insurance applicants. (Personal communication from Dr. H. E. Ungerleider.)

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