Heart chest radiograph

A chest radiograph should be done if the patient has heart failure symptoms. 

Infliximab therapy is associated with increased incidence of respiratory infections of particular concern is potential reactivation of tuberculosis or other granulomatous infections with subsequent dissemination. The FDA recommends that candidates for infliximab therapy should be tested for latent tuberculosis with purified protein derivative, and patients who test positive should be treated prophylactically with isoniazid. However, anergy with a false-negative skin test has been noted in some patients with Crohn s disease, and some experts routinely perform chest radiographs to look for active or latent pulmonary disease. Infliximab also is contraindicated in patients with severe congestive heart failure. The significant cost of infliximab is an important consideration in some patients. 

Fig. 18.25 Posteroanterior (A) and lateral (B) chest radiographs from a child with a univentricular heart after a septation procedure and implantation of a dual-chamber pacemaker. The ventricular lead has been placed in an epicardial position, and the atrial lead is transvenously positioned. (From Lloyd MA, Hayes DL. Pacemaker and ICD radiography. In Hayes DL, Lloyd MA, Friedman PA, editors. Cardiac pacing and defibriUation a clinical approach. Armonk [NY] Futura Publishing, 2000 485-517. Used with permission of Mayo Foundation for Medical Education and Research.)...

Fig. 18.28 Posteroanterior chest radiograph (A) and close-up view (B) from a patient with congenital heart disease and an abandoned dual-chamber endocardial pacing system. Two ventricular epicardial leads are connected with a Y connector to a single chamber ventricular pacemaker. On the close-up view (B) the arrow notes a defect in the lead adaptor just as it exits the connector block.

Bergin CJ, Castellino RA, Blank N, Berry GJ, Sibley RK, Starnes VA (1990) Acute lung rejection after heart-lung transplantation correlation of findings on chest radiographs with lung biopsy results. AJR Am J Roentgenol 155 23-27... 

Figure 2 Chest radiographs of the patient described in Figure 1 obtained on admission (left) and 14days after high-dose, parenteral thiamin treatment (right). On admission, the heart was grossly enlarged, extending downward and to the right, with a cardiothoracic ratio of 0.63. After treatment for 14 days, the cardiothoracic ratio was 0.44. (Modified from Anderson SH, Charles TJ and Nicol AD (1985) Thiamine deficiency at a district general hospital Report of five cases. Quarterly Journal of Medicine 55 15-32.)...

Radiographic examination of the chest of a patient with chronic bronchitis often reveals increased bronchovascular markings in the lower lung area and a somewhat enlarged cardiac silhouette. As right ventricular heart failure becomes more prominent, the cardiac silhouette may enlarge even further. 

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