Skip to main content
PMC home page
British Heart Journal logoLink to British Heart Journal
. 1980 Nov;44(5):577–583. doi: 10.1136/hrt.44.5.577

Use of high kilovoltage filtered beam radiographs for detection of bronchial situs in infants and young children.

J E Deanfield, R Leanage, J Stroobant, A R Chrispin, J F Taylor, F J Macartney
PMCID: PMC482447  PMID: 7437200

Abstract

Determination of atrial situs is of cardinal importance in the analysis of complex congenital heart lesions, and is best predicted from bronchial situs. Previous methods for assessing bronchial morphology, however, are unsuited to the very young patient. To assess bronchial morphology, 100 consecutive patients under 18 months of age (medium 57.5 days) with suspected congenital heart disease were studied by high kilovoltage filtered beam radiographs, before cardiac catheterisation. This low radiation dose technique clearly defined bronchial anatomy in 95 patients. The lengths of the left and right main bronchi were compared and 10 cases (10%) had a ratio less than 1.5 suggesting bronchial isomerism. Discriminant function analysis based on tracheal width and bronchial length enabled clear distinction of right from left bronchi. Four patients had bilateral right and six had bilateral left bronchi. Four of these 10 cases died and had necropsy confirmation of the radiological diagnosis. Practical prediction about cardiac anatomy, particularly the systemic and pulmonary venous return, may be made when bronchial morphology is known.

Full text

PDF
577

Images in this article

579Image
on p.579
579Image
on p.579
580Image
on p.580

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Brandt P. W., Calder A. L. Cardiac connections: the segmental approach to radiologic diagnosis in congenital heart disease. Curr Probl Diagn Radiol. 1977 May-Jun;7(3):1–35. doi: 10.1016/s0363-0188(77)80006-6. [DOI] [PubMed] [Google Scholar]
  2. Caruso G., Becker A. E. How to determine atrial situs? Considerations initiated by 3 cases of absent spleen with a discordant anatomy between bronchi and atria. Br Heart J. 1979 May;41(5):559–567. doi: 10.1136/hrt.41.5.559. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Dunbar J. S. Upper respiratory tract obstruction in infants and children. Am J Roentgenol Radium Ther Nucl Med. 1970 Jun;109(2):227–246. doi: 10.2214/ajr.109.2.227. [DOI] [PubMed] [Google Scholar]
  4. Freedom R. M. The asplenia syndrome: a review of significant extracardiac structural abnormalities in 29 necropsied patients. J Pediatr. 1972 Dec;81(6):1130–1133. doi: 10.1016/s0022-3476(72)80244-0. [DOI] [PubMed] [Google Scholar]
  5. Joseph P. M., Berdon W. E., Baker D. H., Slovis T. L., Haller J. O. Upper airway obstruction in infants and small children. Improved radiographic diagnosis by combining filtration, high kilovoltage, and magnification. Radiology. 1976 Oct;121(1):143–148. doi: 10.1148/121.1.143. [DOI] [PubMed] [Google Scholar]
  6. Landing B. H., Lawrence T. Y., Payne V. C., Jr, Wells T. R. Bronchial anatomy in syndromes with abnormal visceral situs, abnormal spleen and congenital heart disease. Am J Cardiol. 1971 Oct;28(4):456–462. doi: 10.1016/0002-9149(71)90010-5. [DOI] [PubMed] [Google Scholar]
  7. Lev M., Liberthson R. R., Eckner F. A., Arcilla R. A. Pathologic anatomy of dextrocardia and its clinical implications. Circulation. 1968 Jun;37(6):979–999. doi: 10.1161/01.cir.37.6.979. [DOI] [PubMed] [Google Scholar]
  8. Lev M., Liberthson R. R., Golden J. G., Eckner F. A., Arcilla R. A. The pathologic anatomy of mesocardia. Am J Cardiol. 1971 Oct;28(4):428–435. doi: 10.1016/0002-9149(71)90006-3. [DOI] [PubMed] [Google Scholar]
  9. Liberthson R. R., Hastreiter A. R., Sinha S. N., Bharati S., Novak G. M., Lev M. Levocardia with visceral heterotaxy--isolated levocardia: pathologic anatomy and its clinical implications. Am Heart J. 1973 Jan;85(1):40–54. doi: 10.1016/0002-8703(73)90524-3. [DOI] [PubMed] [Google Scholar]
  10. Moller J. H., Nakib A., Anderson R. C., Edwards J. E. Congenital cardiac disease associated with polysplenia. A developmental complex of bilateral "left-sidedness". Circulation. 1967 Nov;36(5):789–799. doi: 10.1161/01.cir.36.5.789. [DOI] [PubMed] [Google Scholar]
  11. PUTSCHAR W. G., MANION W. C. Congenital absence of the spleen and associated anomalies. Am J Clin Pathol. 1956 May;26(5):429–470. doi: 10.1093/ajcp/26.5.429. [DOI] [PubMed] [Google Scholar]
  12. Partridge J. B., Scott O., Deverall P. B., Macartney F. J. Visualization and measurement of the main bronchi by tomography as an objective indicator of thoracic situs in congenital heart disease. Circulation. 1975 Jan;51(1):188–196. doi: 10.1161/01.cir.51.1.188. [DOI] [PubMed] [Google Scholar]
  13. RUTTENBERG H. D., NEUFELD H. N., LUCAS R. V., Jr, CAREY L. S., ADAMS P., Jr, ANDERSON R. C., EDWARDS J. E. SYNDROME OF CONGENITAL CARDIAC DISEASE WITH ASPLENIA. DISTINCTION FROM OTHER FORMS OF CONGENITAL CYANOTIC CARDIAC DISEASE. Am J Cardiol. 1964 Mar;13:387–406. doi: 10.1016/0002-9149(64)90454-0. [DOI] [PubMed] [Google Scholar]
  14. Rose V., Izukawa T., Moës C. A. Syndromes of asplenia and polysplenia. A review of cardiac and non-cardiac malformations in 60 cases withspecial reference to diagnosis and prognosis. Br Heart J. 1975 Aug;37(8):840–852. doi: 10.1136/hrt.37.8.840. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Soto B., Pacifico A. D., Souza A. S., Jr, Bargeron L. M., Jr, Ermocilla R., Tonkin I. L. Identification of thoracic isomerism from the plain chest radiograph. AJR Am J Roentgenol. 1978 Dec;131(6):995–1002. doi: 10.2214/ajr.131.6.995. [DOI] [PubMed] [Google Scholar]
  16. Stanger P., Rudolph A. M., Edwards J. E. Cardiac malpositions. An overview based on study of sixty-five necropsy specimens. Circulation. 1977 Aug;56(2):159–172. doi: 10.1161/01.cir.56.2.159. [DOI] [PubMed] [Google Scholar]
  17. VAN MIEROP L. H., WIGLESWORTH F. W. Isomerism of the cardiac atria in the asplenia syndrome. Lab Invest. 1962 Dec;11:1303–1315. [PubMed] [Google Scholar]
  18. VANPRAAGH R., VANPRAAGH S., VLAD P., KEITH J. D. ANATOMIC TYPES OF CONGENITAL DEXTROCARDIA: DIAGNOSTIC AND EMBRYOLOGIC IMPLICATIONS. Am J Cardiol. 1964 Apr;13:510–531. doi: 10.1016/0002-9149(64)90159-6. [DOI] [PubMed] [Google Scholar]
  19. Van Mierop L. H., Eisen S., Schiebler G. L. The radiographic appearance of the tracheobronchial tree as an indicator of visceral situs. Am J Cardiol. 1970 Oct;26(4):432–435. doi: 10.1016/0002-9149(70)90743-5. [DOI] [PubMed] [Google Scholar]
  20. Wolf E. L., Berdon W. E., Baker D. H. Improved plainfilm diagnosis of right aortic arch anomalies with high kilovoltage-selective filtration-magnification technique. Pediatr Radiol. 1978 Sep 26;7(3):141–146. doi: 10.1007/BF00975436. [DOI] [PubMed] [Google Scholar]

Articles from British Heart Journal are provided here courtesy of BMJ Publishing Group

RESOURCES