Cardiomegaly chest x ray

Cardiomegaly Microchapters
Home
Patient Information
Overview
Historical Perspective
Pathophysiology
Causes
Differentiating Cardiomegaly from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
Chest X Ray
MRI
CT
Echocardiography or Ultrasound
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Cardiomegaly chest x ray On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Cardiomegaly chest x ray
CDC on Cardiomegaly chest x ray
Cardiomegaly chest x ray in the news
Blogs on Cardiomegaly chest x ray
Directions to Hospitals Treating Cardiomegaly chest x ray
Risk calculators and risk factors for Cardiomegaly chest x ray

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Chest X Ray

• Cardiomgaly is traditionally defined as an increase in the cardiothoracic ratio to be > 0.5 on a PA film. To calculate the thoracic ratio, the width of the cardiac silhouette is divided by the width of the entire thoracic cage.
• If the heart is viewed on an AP film, the heart can appear to be artificially enlarged because the X ray beam moves from anterior to posterior direction and therefore the heart which lies anterior is magnified.

  • Postero Anterior (PA) Projection: adult heart is 12 cm from base to apex and 8-9 cm in transverse direction
  • Lateral Projection: The adult heart is 6 cm in the Antero Posterior (AP) direction

X-ray findings for left ventricular enlargement

• Left heart border is displaced leftward, inferiorly, or posteriorly.
• Rounding of the cardiac apex

Cardiomegaly.
Image courtesy of C. Michael Gibson MS. MD

Cardiomegaly in a patients after mitral valve replacement. AP view. Image courtesy of RadsWiki

Cardiomegaly in a patients after mitral valve replacement. Lateral view. Image courtesy of RadsWiki.

X-ray findings for left atrial enlargement

• Double density sign: Occur when the right side of the left atrium pushes into the adjacent lung.
• Convex left atria appendage: usually reflect prior rheumatic heart disease
• Splaying of the carina
• Posterior displacement of the left main stem bronchus on lateral radiograph
• Superior displacement of the left main stem bronchus on frontal view
• Posterior displacement of a barium filled esophagus

Double density sign

Double density sign

X-ray findings for right ventricular enlargement

• Frontal view

• Rounded left heart border
• Uplifted apex

• Lateral view

• Filling of the retrosternal space
• Rotation of the heart posteriorly

X-ray findings for right atrial enlargement

• On a frontal view, the right atrium is visible because of its interface with the right middle lobe.
• Subtle and moderate right atrial enlargement is not accurately determined on plain films because there is normal variability in the shape of the right atrium.