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Chapter 12: THE CHEST ROENTGENOGRAM AND CARDIAC FLUOROSCOPY STATISTICAL GUIDANCE

Certain roentgenologic findings are by themselves diagnostic of a disease; other signs are suggestive of a diagnosis on the basis of statistics only. Nevertheless, the latter can be quite useful by virtue of their high predictive value of a particular disease or a group of similar diseases. Therefore, one should always keep the statistical information in mind.

The incidence of congenital heart disease in patients with right-sided aortic arch increases 10- to 100-fold depending on the anatomic details of the anomaly.2122 Of practical importance, there are only two types of right-sided aortic arch. The first has been called the avian type, implying a normal status for birds but a detrimental one for humans. The overwhelming majority of patients with this type are born with cyanotic congenital heart disease. The second may be called the common type because of its higher incidence in the general population. Most patients with the common type are physiologically normal and have their anomaly incidentally diagnosed on chest radiographs or a barium meal study. The x-ray findings of the two types are similar in the PA view but are quite different in the lateral view Fig. 12-21). The incidence and list of congenital heart diseases with each type20 are shown in Table 12-3. Only 2 percent of patients with the avian type are physiologically normal. Tetralogy of Fallot should be the diagnosis in these patients until proved otherwise.2!,22

Table 12-3: Cardiac Defects Associated with Each Type of Right-Sided Aortic Arch

Type of Anomaly

Table 12-3: Cardiac Defects Associated with Each Type of Right-Sided Aortic Arch

Type of Anomaly

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