Clinical:

History: This patient presented for an Annual Physical Examination. Mild hypertension for 5 years, medicated.

Symptoms: None

Signs: Chest palpation suggested cardiac enlargement. A quiet diastolic murmur was heard.

DDx:

Cardiac – valvular, ischemic, cardiomyopathy

Epicardial – effusion

Extracardiac – fat, mass, fluid, pectus excavatum

Poor Inspiration

Portable imaging technique

Imaging Recommendation

Chest x-ray

Image Assessment

Findings:

The cardiac silhouette was enlarged.  The Cardio-Thoracic Ratio (CTR) measured 31/50 cm – 62%.  A normal ratio should be less than 50%.

The lungs and pleural spaces were clear.  No evidence of alveolar or interstitial edema. No evidence of aortic or coronary artery calcification.

Interpretation:

Enlargement of the cardiac silhouette requiring further investigation. Further investigation with ECG, and Echocardiography, were pending.

Diagnosis:

Enlargement of the Cardiac Silhouette, Cause Not Yet Diagnosed

Discussion:

Potential causes of Enlargement of the Cardiac Silhouette include:

a) Cardiac chamber(s) (atria, ventricles) – related to valvular disease or cardiomyopathy (ischemic, dilated), congenital heart anomalies, other

b) Pericardium – pericardial effusion, pericardial tumor

c) Epicardial – fat, tumor

d) Anterior Mediastinal mass

e) Expiratory phase x-ray

f) PA – Portable x-ray technique

Hence, further history, acquisition of old imaging and subsequent further testing, including imaging, will be required.

Attributions

Figure 8.3A Chest x-ray with an enlarged heart shadow by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.

Figure 8.3B Chest x-ray with an enlarged heart shadow by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.