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8.2: Enlarged Cardiac Silhouette

  • Page ID
    14825
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    Case

    Enlargement of the Cardiac Silhouette, Cause Not Yet Diagnosed

    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

    ODIN Link for Enlarged Cardiac Silhouette images: mistr.usask.ca/odin/?caseID=20160107114411264

    CV-case-1-1-1.jpg
    Figure 8.3A Chest x-ray with an enlarged heart shadow, method 1.

     

    CV-Case-1-2-1024x742.jpg
    Figure 8.3B Chest x-ray with an enlarged heart shadow, method 2.

    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.


    This page titled 8.2: Enlarged Cardiac Silhouette is shared under a CC BY-NC-SA 4.0 license and was authored, remixed, and/or curated by Brent Burbridge and Evan Mah via source content that was edited to the style and standards of the LibreTexts platform; a detailed edit history is available upon request.