Cardiomegaly differential diagnosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor in Chief: Cafer Zorkun, M.D., Ph.D. [2]
Overview
There is a large differential for cardiomegaly, as it is a finding that is seen in many conditions. The differential can be narrowed based on the chamber of the heart affected, and whether the cardiomegaly is caused by dilation or by hypertrophy. Other physical findings, imaging studies, and laboratory findings need to be taken into consideration when determining the underlying diagnosis caused the manifestation of an enlarged heart.
Diseases From Which Cardiomegaly Must Be Distinguished
- Straight back syndrome with pancake heart: This can cause a leftward shift of the heart on the chest x-ray. The heart can be "pancaked" or compressed.
- Expiration: If the chest x-ray is obtained during expiration, the lung volume will be decreased and the cardiac size and aortic size will be relatively increased.
Differentiating Cardiomegaly from other Diseases
In alphabetical order. [1] [2]
- Acromegaly
- Alcoholic cardiomyopathy
- Amyloidosis
- Anemia
- Atrial myxoma
- Carcinoid
- Chronic obstructive pulmonary disease (COPD)
- Congenital heart disease
- Congestive Heart Failure
- Cor pulmonale
- Drugs
- Endocardial fibroelastosis
- Epicardial fat pad
- Fabry's disease
- Hemochromatosis
- Hurler's syndrome
- Hyperparathyroidism
- Hypertension
- Hypertrophic cardiomyopathy
- Hypocalcemia
- Hypomagnesemia
- Hypoparathyroidism
- Hypophosphatemia
- Idiopathic cardiomyopathy
- Ischemic heart disease
- Kyphoscoliosis
- Marfan's syndrome
- Mediastinal mass
- Myocarditis
- Normal athletic heart
- Pompe's disease
- Postradiation
- Pregnancy
- Primary pulmonary hypertension
- Pulmonary embolism
- Renal failure: Acute renal failure and chronic renal failure
- Scleroderma
- Sickle cell disease
- Subacute bacterial endocarditis
- Systemic lupus erythematosus
- Valvular heart disease
Differential Diagnosis of Specific Chamber Enlargements
Left Atrial Enlargement
- Atrial aneurysm
- Infective endocarditis
- Left heart failure
- Mitral regurgitation
- Mitral stenosis
- Mitral valve prolapse
- Myxedma
- Patent ductus arteriosus
- Ventricular septal defect
Left Ventricular Hypertrophy
- Acromegaly
- Alcoholic cardiomyopathy
- Aortic coarctation
- Aortic regurgitation
- Aortic stenosis
- Chronic Renal Failure
- Familial dilated and hypertrophic cardiomyopathy
- Hypertrophic cardiomyopathy (HCM)
- Idiopathic dilated cardiomyopathy
- Mitral regurgitation
- Patent ductus arteriosus
- Restrictive cardiomyopathy
- Thalassemia
Right Atrial Enlargement
- Atrial aneurysm
- Atrial septal defect
- Ebstein's anomaly
- Pulmonic stenosis
- Right heart failure
- Tricuspid prolapse
- Tricuspid regurgitation
- Tricuspid stenosis
- Tumor
Right Ventricular Hypertrophy
- Atrial septal defect
- Chronic obstructive pulmonary disease (COPD)
- Cor pulmonale
- Eisenmenger's Syndrome
- Left ventricular hypertrophy or Left ventricular dilation
- Mitral stenosis
- Pickwickian syndrome
- Pulmonic regurgitation
- Pulmonic stenosis
- Tetralogy of fallot
- Transposition of the great vessels
- Tricuspid regurgitation
- Ventricular septal defect