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Chest Radiography Pearls in Select Adult Congenital Heart Disease
William A Schiavone1, David S Majdalany2
1Cleveland Clinic Heart and Vascular Institute, Cleveland, OH 44120, USA.
Insights
Adult congenital heart disease (ACHD) affects individuals with heart defects, often diagnosed in adulthood. Recognizing chest X-ray (CXR) features aids in diagnosing and managing ACHD, complementing other imaging methods.
Area of Science:
- Cardiology
- Radiology
- Medical Imaging
Background:
- Adult congenital heart disease (ACHD) encompasses a spectrum of native and post-intervention cardiac anomalies.
- While many congenital heart defects are identified and treated in childhood, subtle cases may elude diagnosis until adulthood.
- Physiological changes in adulthood, such as pregnancy or arrhythmias, can unmask previously undiagnosed ACHD.
Purpose of the Study:
- To highlight the diagnostic utility of chest X-ray (CXR) in adult patients with congenital heart disease (ACHD).
- To emphasize the importance of recognizing specific CXR findings for ACHD diagnosis and patient monitoring.
- To underscore CXR's role as a valuable tool complementing echocardiography in ACHD management.
Main Methods:
- Review of chest X-ray (CXR) findings in adult congenital heart disease (ACHD) patients.
- Correlation of radiographic features with clinical presentation and hemodynamic status.
- Comparative analysis of CXR utility against other diagnostic modalities like echocardiography.
Main Results:
- Chest X-ray (CXR) demonstrates characteristic features, or constellations of features, in a significant proportion of ACHD patients.
- Radiographic findings on CXR can provide crucial clues for the initial diagnosis of ACHD in adults.
- The interpretation of CXR findings is essential for the long-term follow-up and management of ACHD patients.
Conclusions:
- Chest X-ray (CXR) is an indispensable imaging modality for the diagnosis and management of adult congenital heart disease (ACHD).
- Proficiency in interpreting CXR is a valuable skill for clinicians managing ACHD patients.
- CXR serves as a critical, accessible tool that enhances the diagnostic capabilities in ACHD, particularly when integrated with echocardiography.
Abstract:
Congenital heart disease in adult patients (ACHD) includes individuals with native anatomic deformities and those who have benefited from corrective, ameliorative, or interventional heart and vascular interventions. Congenital heart disease is the most common birth defect, although with interventions most survive into adulthood. Newborns and children with complex congenital heart diseases that feature cyanosis fail to thrive, and once this is identified, heart failure can promptly undergo diagnostic evaluations and treatment. However, patients with simple congenital heart disease and subtle clinical signs and symptoms may escape diagnosis until adulthood or experience changes in their cardiac hemodynamics and physiology in settings such as pregnancy or newly diagnosed arrhythmias. The chest X-ray (CXR) is the most common X-ray among all radiological procedures. Individual features or a constellation of features on a CXR are often present in patients who have congenital heart disease. The ability to recognize these CXR features is a valuable skill for making the diagnosis of ACHD and for following these patients as they age, and can complement echocardiographic findings. When used well to diagnose ACHD, the CXR will be the sharpest arrow in the quiver.
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