Radiographic Evaluation of the Child with Heart Disease

Despite the development of advanced imaging techniques, the chest radiograph remains an important tool in evaluation of the child with heart disease in the acute care setting. A systematic approach should be used in reviewing chest radiographs, with the “ABCD’S” mnemonic serving as a useful checklist of items to evaluate. On the chest radiograph, abnormalities in cardiac size and shape, pulmonary vasculature, airway position and morphology, and situs and osseous structures may be encountered in children with heart disease. The differential diagnoses of massive cardiothymic silhouette enlargement are relatively limited. Specific chamber enlargement may be determined in older children. Abnormalities in the radiographic appearance of the pulmonary vasculature reflect underlying alterations in pulmonary blood flow. Airway position deviates from normal in the presence of a vascular ring/pulmonary sling or mediastinal mass. Situs abnormalities detected on chest radiographs should prompt additional cardiac evaluation since the incidence of congenital heart disease is greater than normal in such cases. Osseous abnormalities may be seen on the chest radiograph in association with cardiovascular lesions or as a result of medical and surgical treatment for cardiovascular disease.