Heart size is almost always a component of a chest X-ray report, we mention it even when we think the radiograph is normal. This is not useful information unless we have an appreciation of how to accurately assess heart size and then provide some further analysis if the heart is enlarged. When we visually assess the heart size as normal it is sufficient to simply state this, but when the heart appears enlarged we should define this further with a cardiothoracic ratio and then assess other features that might indicate the physiology behind this enlargement. This will involve reviewing old radiographs, critically analysing the pulmonary vasculature and making an assessment of associated features for indications of specific chamber enlargement or valvular disease. This initial radiological assessment can be the first recognition of significant pathology and is a diagnostic opportunity that should not be missed.
The purpose of this presentation is to re-examine this familiar subject, provide some new insights into chest radiograph interpretation, correlate the CXR findings with other imaging studies and provide clues to help in the recognition of mimics of cardiac enlargement.
The presentation will use examples of borderline, definite and massive cardiac enlargement, and emphasise the importance of understanding the influence of radiographic technique on interpretation.
• To review the definitions of cardiomegaly and categorise the causes of this finding
• To define how to assess heart size on CXR and CT
• To revise appearances and causes of specific chamber enlargement
• To highlight mimics of cardiac enlargement
• To understand the importance of accurate assessment of heart size
• To be able to critically analyse the chest radiograph for this feature
1 CPD credit
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Dr Simon Padley
Dr Simon Padley is a Consultant Radiologist who leads the lung cancer imaging and intervention service and cardiac CT service at the Royal Brompton and Harefield NHS Foundation Trust and Chelsea and Westminster Hospital NHS Foundation Trust. He was the recipient of a 1991-1992 thoracic imaging fellowship at Vancouver General Hospital. Dr Padley specialises in thoracic and vascular imaging and intervention. He teaches cardiac and thoracic imaging as a course director.
Dr Padley has been a speaker on thoracic imaging at the European Congress of Radiology Annual Meeting, European Society of Thoracic Imaging and World Congress of Thoracic Imaging meeting in the past five years. He is peer reviewer for a number of journals. He has authored more than 30 book chapters and 100 peer reviewed papers. He is the current lead for the Accreditation Sub-committee of the British Society of Cardiovascular Imaging.