Radiographic Findings by Diagnosis: Cardiomyopathies




Key Points




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    Chest radiography in the context of cardiomyopathies is an important means by which to incrementally increase the sensitivity and specificity of determination of the presence of, particularly, cardiomegaly associated left-sided heart failure.


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    The chest radiographic appearance of the different forms of cardiomyopathy is established by the expected enlargement of specific chambers (dilated cardiomyopathy: all chambers; hypertrophic cardiomyopathy: left atrium; and restrictive cardiomyopathy: both atria), and the relative amounts of expected left (hypertrophic cardiomyopathy) versus biventricular failure (dilated cardiomyopathy, restrictive cardiomyopathy).





Acquired Myopathies


Hypertrophic Cardiomyopathy


Enlargement of the left atrium is present in the majority of cases of hypertrophic cardiomyopathy ( Figs 14-1 to 14-4 ). Left atrial enlargement is greater in patients with hypertrophic cardiomyopathy when there is concurrent mitral insufficiency. The degree of left ventricular enlargement is variable but is usually mild and consistent with left ventricular hypertrophy. About 50% of cases have cardiomegaly, usually mild to moderate. Mitral annular calcification is common.




Figure 14-1


Hypertrophic cardiomyopathy. On the posteroanterior radiograph, the cardiothoracic ratio is mildly increased, and the upper left heart border is more prominent due to left atrial appendage enlargement. The lateral radiograph reveals posterior left ventricular displacement behind the supradiaphragmatic inferior vena cava.



Figure 14-2


Anteroposterior and lateral chest radiographs of a patient with hypertrophic cardiomyopathy of a mild form. The left atrial appendage is likely enlarged, depicted by a straightening of the left superior heart border on the anteroposterior chest radiograph. There is no frank cardiomegaly. There is borderline posterior displacement of the left ventricular silhouette and probable enlargement of the left atrial silhouette on the lateral chest radiograph.

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Apr 10, 2019 | Posted by in General Surgery | Comments Off on Radiographic Findings by Diagnosis: Cardiomyopathies

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