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This cardiomegaly is different ! . . . It can easily fool us !

Posted Mar 31 2012 10:21am

By statistics cardiomegaly   often implies  ventricular enlargement (especially left ventricular) .Right ventricle generally do not enlarge the  CT ratio until late stages .

More important  is the impact of right atrial enlargement on the CT ratio. Here was a  patient referred to echo lab for evaluation of cardiomegaly

The x-ray chest  was suggesting a definite LV enlargement.  To my surprise  the LV was perfectly  measuring a normal dimension .

The right atrium was huge and measuring  more than 5 cms . This increased the CTR.

The following illustration  tries to create echo equivalent of transverse CT diameter by rotating apical 4 chamber view by 90 degrees.

The right and left atrium was significantly dilated . This patient had atrial fibrillation and the atrial enlargement was due to chronic AF.

Final message

Cardimegaly in  X- ray chest do not  necessarily  mean ventricular enlargement.

Pure atrio-megaly  especially right atrial enlargement can dramatically increase the CT ratio.

This is not a big  discovery , still fellows need   to reinforce  this fact  , as  mistakes are most often committed in well  known things !


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