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The plain chest film as an unreliable method to determine left ventricular size
Insights
Plain chest X-rays may underestimate left ventricular (LV) size in cardiac patients. Echocardiography provides a more accurate assessment of LV dimensions and function in severe coronary artery disease.
Area of Science:
- Cardiology
- Medical Imaging
- Diagnostic Techniques
Background:
- Severe coronary artery disease (CAD) can significantly impact left ventricular (LV) size and function.
- Accurate assessment of LV dimensions is crucial for managing cardiac patients.
- Traditional imaging modalities like plain chest films are commonly used for initial evaluation.
Observation:
- A case report highlighted a discrepancy between plain chest film and echocardiogram findings in a patient with severe CAD.
- The chest film indicated a normal cardiothoracic ratio (50%), suggesting normal LV size.
- The echocardiogram revealed a dilated LV with reduced wall motion and low ejection fraction, characteristic of cardiomyopathy.
Findings:
- Echocardiographic findings of LV dilation and dysfunction were confirmed by cardiac catheterization and angiography.
- The plain chest film's assessment of LV size was inconsistent with more definitive imaging results.
- This case underscores the limitations of plain chest films in evaluating LV morphology in complex cardiac conditions.
Implications:
- Echocardiography may be a more reliable tool than plain chest films for assessing LV size in patients with known or suspected cardiac disease.
- Consideration should be given to utilizing echocardiography earlier in the diagnostic pathway for cardiac patients.
- This highlights the importance of correlating imaging findings and considering advanced modalities when clinical suspicion is high.
Abstract:
This case report describes the disparity between the findings of the plain chest film and the echocardiogram in a patient with severe coronary artery disease. Whereas the plain chest film shows a normal cardiothoracic ratio of 50% indicating normal LV size, the echocardiogram shows features characteristic of a dilated cardiomyopathic left ventricle with low amplitude of wall motion and consequently low ejection fractoin. These echocardiographic findings were confirmed at cardiac catheterization and angiography. We propose the use of echo instead of the plain chest film in the evaluation of LV size in the cardiac patient.