Cardiomega

ly

Normal heart AP view

Normal heart lateral view

Cardiomegaly

Measurement of cardiac size

Cardiothoracic ratiois measured on a PA chest x-ray, and is the ratio of:
maximal horizontal cardiac diameter
maximal horizontal thoracic diameter (inner edge of ribs / edge of
pleura)
A normal measurement should be less than 0.5.

Normal

Cardiomegaly

 If clinical concern exists then echocardiography

is required. It will not only be able to assess
cardiac function (cardiac size being a surrogate
marker of function) but also exclude other
causes of enlargement of the cardiac silhouette
(e.g.pericardial effusion).
In some situations an increased cardiothoracic
ratio on a PA radiograph may simply result from
aprominent epicardial fat padand due to
expiration rather than from due cardiomegaly.

Cardiomegaly AP view

Cardiomegaly Lateral view

Modality:X-ray
AP and lateral chest x-rays demonstrate markedly enlarged
cardiacsilhouette. There is a double contour to the right heart
border and splaying of the carina.

- Red : Splayed carina

and
double contour.
- Blue : Most lateral
contour is due to the
right atrium
- Orange : more medial
contour due to the
left atrium

Cardiomegaly CT Scan
Single image from a
CT (obtained for
unrelated reasons) at
the level of the heart
confirms
cardiomegaly, with
dilatation of all
chambers (the left
atrium most
prominent). No
pericardial effusion.

Left atrialenlargement
Acquired
Mitral stenosis
Mitral regurgitation
Left ventricular failure
Left atrial myxoma
Congenital
Ventricular septal defect (VSD)
Patent ductus arteriosus (PDA)

Left atrialenlargement

Right Atrial
Enlargement
Right atrial enlargementis less common, and
harder to delineate on chest radiograph, thanleft
atrial enlargement
Causes
Raised right ventricular pressures
pulmonary arterial hypertension
cor pulmonale

Valvular disease
tricuspid regurgitation
tricuspid stenosis
Ebstein's anomaly

Atrial septal defect (ASD)

Atrial fibrillation (AF)
Dilated cardiomyopathy

AP view

Lateral
view

LEFT VENTRICULAR
ENLARGEMENT
Pressure overload: HTN,

AS
Volume overload: VSD,
AR, MR
Aneurysm
Cardiomyopathy

PA CXR

Enlarges in post, inferior and leftward

direction
Increased CTR
Larger radius of curvature of left heart border
Downturned cardiac apex
Depression of left hemidiaphragm

Left ventricular enlargement

LAT CXR

Increased convexity of posteroinferior cardiac margin

Hofman rigler rule: posterior cardiac margin projects >1.8
cm post to IVC measured at a point 2cm above intersection
of IVC with right hemi diaphragm

RIGHT VENTRICULAR
ENLARGEMENT
PV stenosis
Cor pulmonale
ASD
Tricuspid regurgitation
Secondary to LVF

PA CXR
Only extreme dilatation
causes signs on frontal view
Straightening/ convexity of
left upper cardiac contour
Upturned cardiac apex
Left upper cardiac margin
parallels left main stem
bronchus as a long convex
curvature
Large appearance of main
pulmonary artery
Occurs higher on the left
heart border b/w left
ventricular contour and
pulmonary outflow tract

LAT CXR
Prominent convexity of ant heart
border >1/3 distance from anterior
cardiophrenic sulcus to sternal angle
Increased size prominent in
retrosternal area

Thank you
Reference:
Radiopaedia.org