Cardiomegaly chest x ray

Cardiomegaly Microchapters

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

## Overview

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Cardiomegaly is easily visualized on chest x ray. Cardiomegaly is traditionally defined as a cardiothoracic ratio that is more than 0.5 on a PA film. Other findings on chest x ray can help to determine the specific chamber that is contributing most to the enlargement of the heart.

## Chest X Ray

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* Cardiomegaly 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: The 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

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* 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

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* 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

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* 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

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* 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.

## References

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