The availability of surgical procedures for the treatment of congenital malformations of the heart in children has made necessary an increasing accuracy in their diagnosis. Many malformations require, for accurate identification, an analysis of data obtained clinically, by conventional chest radiography, and by cardiac catheterization and∕or cardioangiography. Since the conventional chest film is usually the most common study in conjunction with clinical examination, it is important to use it as fully and accurately as the method allows. The status of the pulmonary vasculature is one criterion in reaching a radiologic diagnosis by the relatively simple technic of teleroentgenography. A radiologic diagnosis of increased or decreased pulmonary vascularity may require actual measurements of the vessels on the chest film, but is usually obtained from a general impression of the shadows of the pulmonary fields. Measurements have been undertaken in adults (5), but in children with congenital heart disease, this procedure is complicated by the poor definition of the vessels (sometimes associated with active vascular engorgement or congestive failure) and the difficulty of evaluating an absolute measurement in relation to any variable reference standard such as height, weight, chest size, or other somatic measurement in the growing individual. The present study was undertaken in an effort to evaluate the ability to appreciate increased or decreased pulmonary vascularity in conventional radiographs of the chest in children with congenital cardiovascular malformations of a known nature. It was hoped thereby to determine the degree of security with which deviations from the normal could be recognized in undiagnosed malformations. Materials and Methods Films of patients with known and proved congenital cardiovascular disease were obtained from the files of the Department of Radiology of Children's Hospital (Cincinnati, Ohio). Only cases which would be expected to have altered pulmonary vascular patterns, such as left-to-right shunts, pulmonic stenosis, or similar malformations, were included. All patients had been studied by angiocardiography, cardiac catheterization, surgery, autopsy, or a combination of two or more technics, so that their pulmonary vascular status could be classified with reasonable security. The selection of films was made by a group of three physicians from the Departments of Cardiology and Radiology, experienced in the diagnosis of congenital cardiovascular disease. Only films which were unanimously considered to show definite over- or under-vascularity, and with which the cardiopulmonary studies were in accord, were accepted for study. Instances of “normal” vascularity were eliminated, notwithstanding abnormal cardiopulmonary studies. Films obtained after operation or from cases with coincidental lung disease were also excluded.
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Arnois et al. (1959) studied this question.