statdx/docs_md/articles/enlarged-cardiac-silhouette_13d59c6a-0f7f-4389-8d8c-f19ca039e446.md

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Enlarged Cardiac Silhouette	13d59c6a-0f7f-4389-8d8c-f19ca039e446	key value df804626-c042-4296-96e3-836a6da50fd6 Gregory Kicska, MD, PhD	name slug treeNodeId Cardiac cardiac fa90100b-619c-430e-8074-b5b9789bab39 name slug treeNodeId Differential Diagnosis differential-diagnosis 952326a0-b3ea-4a21-aa7a-d796cc9325ed name slug treeNodeId Enlarged Cardiac Silhouette enlarged-cardiac-silhouette null	Cardiac	c4c4d705-71ba-4631-be39-f4b35c596710	5	03/17/22	Enlarged Cardiac Silhouette	Cardiac, Differential Diagnosis, Enlarged Cardiac Silhouette	Enlarged Cardiac Silhouette | STATdx	Enlarged Cardiac Silhouette	DDX	Cardiac Differential Diagnosis Enlarged Cardiac Silhouette

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title: "Enlarged Cardiac Silhouette" docid: "13d59c6a-0f7f-4389-8d8c-f19ca039e446" authors:

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ESSENTIAL INFORMATION

• Key Differential Diagnosis Issues

  • Pericardial space fluid: Globular enlargement
  • Cardiac chamber enlargement: Characteristic contour abnormality, such as filling of retrosternal clear space in right ventricle enlargement
  • Pericardial mass: Focal contour irregularity

• Helpful Clues for Common Diagnoses

  • Ischemic Cardiomyopathy - Subendocardial fat or calcium, left ventricle (LV) wall thinning in coronary distribution, dense coronary calcifications - MR shows subendocardial or transmural delayed enhancement in coronary artery distribution
  • Valvular Disease - Valvular calcifications most common - MR cine or phase contrast shows flow jets
  • Heart Failure Exacerbation - Coexistent signs of pulmonary edema
  • Pericardial****Effusion - New globular heart enlargement on radiograph, fluid-density pericardial fluid on CT - Hemopericardium suggested by high-density pericardial fluid or neoplasm history (lung, breast, melanoma)

• Helpful Clues for Less Common Diagnoses

  • Nonischemic Dilated Cardiomyopathy - Dilated LV, thin wall, LVEF < 40% - Either no delayed enhancement present or enhancement is not subendocardial
  • Pericardial Mass - Pericardial cyst: Circumscribed fluid density at right more than left cardiophrenic angle - Pericardial fat pad: Fat density most commonly at right cardiophrenic angle

• Helpful Clues for Rare Diagnoses

  • Left Ventricle Aneurysm - True aneurysm - Post infarct wall thinning, dilatation, and associated thrombus - Most often present along apical anterior or lateral wall - False aneurysm - Ruptured myocardium contained by pericardial adhesions - Most commonly seen at infero-lateral or inferior basal LV wall segments - Neck narrower than internal diameter

Images

Selected Images

Ischemic Cardiomyopathy Short-axis delayed contrast-enhanced image shows subendocardial enhancement in the septal and anterior wall at the base. The patient had hypokinesis and wall thinning at this location.

Ischemic Cardiomyopathy Short-axis delayed contrast-enhanced image shows subendocardial enhancement in the septal and anterior wall at the base. The patient had hypokinesis and wall thinning at this location.

Valvular Disease Axial CECT shows an enlarged right atrium in a patient with severe tricuspid regurgitation. Radiograph showed rightward deviation of the right heart border. Regurgitant jet was seen on MR.

Additional Images

Heart Failure Exacerbation Frontal radiograph shows a normal cardiac silhouette in a patient with ischemic cardiomyopathy and a 40% ejection fraction. Compare with the next image, which was acquired 1 month later.

Heart Failure Exacerbation Frontal radiograph shows marked enlargement of the cardiac silhouette. The patient presented with increasing shortness of breath. Large pericardial effusion was found with presumed etiology of heart failure exacerbation.

Left Ventricle Aneurysm Frontal radiograph shows left cardiac border contour deformity . CT showed abdominal fat, which had herniated into the left cardiophrenic space.