Cardiomegaly differential diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Synonyms and keywords: pseudo-cardiomegaly; pseudocardiomegaly

Cardiomegaly must be distinguished from pseudo-cardiomegaly, a scenario in which the apparent size of the heart is artificially increased. Disorders and conditions which falsely increase the apparent size of the heart include straight back syndrome, a disorder in which the heart is "pancaked" or compressed; and obtaining the chest x-ray during expiration at which time the diameter of the lungs is decreased and the relative diameter of the heart and aorta is increased.

• Epicardial fat pad
• 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. The traditional metrics used to diagnose cardiomegaly do not apply in this case.
• Kyphoscoliosis
• Mediastinal mass
• Pectus excavatum
• Pulmonary blastoma^[1]
• 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.
• Thymus tumor

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