Topography and roentgenotomy of the heart

The heart with its surrounding membrane - pericardium - is located in the thoracic cavity. Two of the three hearts are located to the left of the median plane, and one third to the right. From the sides and partially in front, most of the heart is covered with prisoners in the pleural sacs by the lungs. A significantly smaller part of the heart in front is attached to the sternum and to the costal cartilage.

The upper border of the heart passes along the line connecting the upper edges of the cartilages of the right and left third ribs. The right border descends from the level of the upper edge of the right third of the right third of the cartilage V vertically down to the cartilage V of the right rib (1-2 cm to the right of the sternum margin). The lower boundary is drawn along a line that extends from the right-rib cartilage V to the apex of the heart. This line is projected in the left fifth intercostal space by 1.0-1.5 cm to the inside of the mild-tootonic line. The left border of the heart extends from the upper edge of the third branch of the left rib, starting at the midpoint of the distance between the left edge of the sternum and the left median with a nonclavicular line, and continues to the apex of the heart. The right and left atrioventricular orifices are projected onto the anterior thoracic wall along an oblique line from the sternum end of cartilage III of the left rib to the cartilage of the VI right rib. The left atrioventricular aperture is on this line at the level of cartilage III of the left rib, the right - above the place of attachment of the cartilage V of the right rib to the sternum. The aortic aperture lies behind the left edge of the sternum at the level of the third costal gap, the opening of the pulmonary trunk - above the attachment site of the hviol III of the left rib to the sternum

In adults, depending on the type of constitution, the heart has a different shape. Thus, in people with a dolichomorph type of constitution, the axis of the heart is oriented vertically and the heart in shape resembles a hanging drop ("drip heart"). In people of the brachymorph type of physique, in which the diaphragm is relatively high, and the angle between the long axis of the heart and the middle plane of the body is close to the straight, the heart occupies a horizontal position (the so-called transverse or recumbent heart). The horizontal position of the heart in women is more common than in men. In people of the mesomorphic type of constitution, the heart occupies an oblique position (the angle between the long axis of the heart and the median plane of the body is 43-48 °).

When examining with X-rays directed from the front in front (front view), the heart of a living person appears as an intense shadow located between the light pulmonary fields. This shadow has the shape of an irregular triangle whose base faces the diaphragm. The shadows of the organs located in front and behind the heart (sternum, organs of the posterior mediastinum and thoracic spine) are also superimposed on the shadow of the heart, its large vessels. The contours of the shadow of the heart have a series of protuberances called arcs. On the right contour of the heart, the smoothed upper arc is clearly visible, the upper part of which corresponds to the superior vena cava, and the lower one - the convexities of the ascending part of the aorta, and the lower arch formed by the right atrium. Above the upper arc there is another small arc (convexity) formed by the outer contour of the right brachiocephalic vein. The left contour of the heart forms 4 arcs:

• lower - the largest, passing along the edge of the left ventricle;
• arc of the protruding abdomen of the left atrium;
• arc of the pulmonary trunk and
• the upper arc corresponding to the aortic arch and the beginning of its descending part.

In the region of the arcs formed by the left ventricle and the left ear, the heart contour has an indentation (interception), called the waist of the heart, which separates it from the large vessels.

In an adult, the heart can normally have on the roentgenogram three different positions:

• oblique, inherent in most people;
• horizontal;
• vertical ("drip heart").