Radiographic Evaluation of the Child with Heart Disease

  • Aparna JoshiEmail author


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.


Radiographic evaluation Chest x-ray Situs Vascular ring Pulmonary sling Pediatric heart disease 


  1. 1.
    Applegate KE, Goske MJ, Pierce G, Murphy D. Situs revisited: imaging of the heterotaxy syndrome. Radiographics. 1999;19:837–52.CrossRefGoogle Scholar
  2. 2.
    Culham JA, Mawson JB. Chest radiography in pediatric cardiovascular disease. In: Coley BD, editor. Caffey’s pediatric diagnostic imaging. 12th ed. Philadelphia: Elsevier; 2013. p. 684–8.Google Scholar
  3. 3.
    Donnelly LF, Gelfand KJ, Schwartz DC, Strife JL. The wall to wall heart: differential diagnosis for massively large cardiothymic silhouette in newborns. Appl Radiol. 1997;26:23–8.CrossRefGoogle Scholar
  4. 4.
    Grotenhuis HB, Zhou C, Tomlinson G, et al. Cardiothoracic ratio on chest radiograph in pediatric heart disease: how does it correlate with heart volumes at magnetic resonance imaging? Pediatr Radiol. 2015;45:1616–23.CrossRefGoogle Scholar
  5. 5.
    Haller JO, Slovis TL, Joshi A. Pediatric radiology. 3rd ed. Heidelberg: Springer; 2005.Google Scholar
  6. 6.
    Laya BF, Goske MJ, Morrison S, et al. The accuracy of chest radiographs in the detection of congenital heart disease and the diagnosis of specific congenital cardiac lesions. Pediatr Radiol. 2006;36:677–81.CrossRefGoogle Scholar
  7. 7.
    Ravin CE. Radiographic analysis of pulmonary vascular distribution: a review. Bull NY Acad Med. 1983;59:728–43.Google Scholar
  8. 8.
    Strife JL, Sze RW. Radiographic evaluation of the neonate with congenital heart disease. Radiol Clin N Am. 1999;37:1093–107.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Pediatric Imaging, Children’s Hospital of MichiganDetroitUSA
  2. 2.Wayne State University School of MedicineDetroitUSA

Personalised recommendations