Chest X-ray Level 2 Tutorial: Congestive Heart Failure
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Tutorial: Congestive Heart Failure
Learn an approach to CHF findings on chest x-ray
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Tutorial: Congestive Heart Failure Vessel to Bronchus ratio
Lessons
42
Times Practiced
1284
Cases Completed
1h 24m
Total Time spent
1m 24s
Average Time
Progress
Accuracy
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Accuracy
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1 Pathophysiology Pathophysiology
2 Enlarged Heart Enlarged Heart
Current lesson 3 Vessel to Bronchus ratio Vessel to Bronchus ratio
4 Vascular Redistribution Vascular Redistribution
5 Peribronchial Cuffing Peribronchial Cuffing
6 Kerley lines Kerley lines
7 Alveolar Edema Alveolar Edema
8 Fluid in fissures Fluid in fissures
9 Fluid in Pleural Space Fluid in Pleural Space
10 CHF Summary CHF Summary
Vessel to Bronchus ratio
When a vessel is seen "end on", it appears as a white circle (it is fluid filled):


When an airway is seen "end on", it appears as a black circle (it is air filled):


Larger vessels typically run alongside larger airways. We can compare the diameters of the vessels compared to the diameters of the airways.

Normally, the vessels will be about the same size as the airways at the level of the hilum (in other words, in the middle of the lungs). In the top portion of the lungs, the vessels are a little smaller (due to gravity) than the airways. In the bottom of the lungs, the vessels are a little larger than the airways.

If the vessels are a lot larger than the airways, then vascular congestion due to increased hydrostatic pressure due to increase left atrial pressure should be considered. This is a sign of congestive heart failure.

Example of vessel similar in size to airway (which is normal). Vessel (red arrow) is slightly smaller than the airway (yellow arrow):


In this example, the vessel is much larger than the airway:


On the lateral chest x-ray, a lot of airways and vessels travel parallel to the x-ray beam and can be seen more prominently. In this example, the vessel is much larger than the airway. Red = vessel, yellow = airway: