Ross
110 lines
6.5 KiB
Markdown
110 lines
6.5 KiB
Markdown
---
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title: "Enlarged Cardiac Silhouette"
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docid: "13d59c6a-0f7f-4389-8d8c-f19ca039e446"
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authors:
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- key: "df804626-c042-4296-96e3-836a6da50fd6"
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value: "Gregory Kicska, MD, PhD"
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breadcrumbs:
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-
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name: "Cardiac"
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slug: "cardiac"
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treeNodeId: "fa90100b-619c-430e-8074-b5b9789bab39"
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-
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name: "Differential Diagnosis"
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slug: "differential-diagnosis"
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treeNodeId: "952326a0-b3ea-4a21-aa7a-d796cc9325ed"
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-
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name: "Enlarged Cardiac Silhouette"
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slug: "enlarged-cardiac-silhouette"
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treeNodeId: null
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category: "Cardiac"
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documentVersionId: "c4c4d705-71ba-4631-be39-f4b35c596710"
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imageCount: 5
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lastUpdated: "03/17/22"
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pageDescription: "Enlarged Cardiac Silhouette"
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pageKeywords: "Cardiac, Differential Diagnosis, Enlarged Cardiac Silhouette"
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pageTitle: "Enlarged Cardiac Silhouette | STATdx"
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enhancedTitle: "Enlarged Cardiac Silhouette"
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type: "DDX"
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breadcrumbs:
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- "Cardiac"
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- "Differential Diagnosis"
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- "Enlarged Cardiac Silhouette"
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---
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# ESSENTIAL INFORMATION
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- ## Key Differential Diagnosis Issues
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- Pericardial space fluid: Globular enlargement
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- Cardiac chamber enlargement: Characteristic contour abnormality, such as filling of retrosternal clear space in right ventricle enlargement
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- Pericardial mass: Focal contour irregularity
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- ## Helpful Clues for Common Diagnoses
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- **Ischemic Cardiomyopathy**
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- Subendocardial fat or calcium, left ventricle (LV) wall thinning in coronary distribution, dense coronary calcifications
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- MR shows subendocardial or transmural delayed enhancement in coronary artery distribution
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- **Valvular Disease**
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- Valvular calcifications most common
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- MR cine or phase contrast shows flow jets
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- **Heart Failure Exacerbation**
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- Coexistent signs of pulmonary edema
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- **Pericardial****Effusion**
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- New globular heart enlargement on radiograph, fluid-density pericardial fluid on CT
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- Hemopericardium suggested by high-density pericardial fluid or neoplasm history (lung, breast, melanoma)
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- ## Helpful Clues for Less Common Diagnoses
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- **Nonischemic Dilated Cardiomyopathy**
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- Dilated LV, thin wall, LVEF < 40%
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- Either no delayed enhancement present or enhancement is not subendocardial
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- **Pericardial Mass**
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- Pericardial cyst: Circumscribed fluid density at right more than left cardiophrenic angle
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- Pericardial fat pad: Fat density most commonly at right cardiophrenic angle
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- ## Helpful Clues for Rare Diagnoses
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- **Left Ventricle Aneurysm**
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- True aneurysm
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- Post infarct wall thinning, dilatation, and associated thrombus
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- Most often present along apical anterior or lateral wall
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- False aneurysm
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- Ruptured myocardium contained by pericardial adhesions
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- Most commonly seen at infero-lateral or inferior basal LV wall segments
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- Neck narrower than internal diameter
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## Images
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### Selected Images
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**Ischemic Cardiomyopathy**
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*Short-axis delayed contrast-enhanced image shows subendocardial enhancement <img src='img/arrows/WS.png'/> in the septal and anterior wall at the base. The patient had hypokinesis and wall thinning at this location.*
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**Ischemic Cardiomyopathy**
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*Short-axis delayed contrast-enhanced image shows subendocardial enhancement <img src='img/arrows/WS.png'/> in the septal and anterior wall at the base. The patient had hypokinesis and wall thinning at this location.*
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**Valvular Disease**
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*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.*
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### Additional Images
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**Heart Failure Exacerbation**
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*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.*
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**Heart Failure Exacerbation**
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*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.*
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**Left Ventricle Aneurysm**
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*Frontal radiograph shows left cardiac border contour deformity <img src='img/arrows/WS.png'/>. CT showed abdominal fat, which had herniated into the left cardiophrenic space.*
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