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A patient with cardiomegaly on Chest Xray
Peter Ruygrok
Mrs DD
65 year old woman Persistent cough for approx. 4 years Investigated by respiratory physicians Diagnosed - Upper airway cough syndrome
Past history of excision carotid tumour
Examination - normotensive, grade 2/6 systolic murmur, fixed split
second sound ECG & CXR CT chest showed mildly dilated pulmonary arteries
CXR
CXR – CTR 53%
ECG
Transthoracic echo
Transoesophageal echocardiogram
ASD closure – 20mm Amplatzer occluder
Chest Xray - quality
Good deep inspiration
Check it is a PA film
Important if there is a change from previous CXR – even if CTR still < 50% (e.g. 38% to 45%)
Other clues on CXR to assist diagnosis
Cardiac contours - RA or LA enlargement
Prominent PA
Prominent or unfolded ascending aorta
Lung fields - Evidence of heart failure
Plethora
Pulmonary arteries
Cardiac contours on CXR
Causes of cardiomegaly
Revisit clinical history and examination findings
History Previous MI
SOB
Malignancy
Risk factors
Exercise
Atrial fibrillation
Thyroid problems
Causes of cardiomegaly
Examination findings Murmurs
Heart failure
Wheeze
Crackles
Raised JVP
Oedema
ECG
Causes of cardiomegaly
Hypertension Valvular heart disease Ischaemic heart disease – previous MI Dilated cardiomyopathy HOCM Pericardial effusions – e.g. malignancy Right heart dilatation – Pulmonary hypertension ASD Thyroid disorders Infiltrative heart disease – amyloid Congenital heart disease
Key learning points
Cardiomegaly on CXR should be investigated further
Think of possible causes & look for clinical clues that may assist diagnosis
An echocardiogram is recommended
CXR’s pre & post LVAD implantation, and post transplantation