Abnormal Cardiac Shadow

CLINICAL DIAGNOSTIC MANUAL

An abnormal cardiac shadow on a chest X-ray refers to a change in the size, shape, or contour of the heart’s silhouette. This finding can indicate various pathological conditions affecting the heart and surrounding structures.

Identifying the underlying cause is crucial, as some conditions may require prompt intervention to prevent serious complications. Evaluating an abnormal cardiac shadow involves a detailed analysis of clinical symptoms and performing complementary tests to confirm the diagnosis.

Pathology	Clinical Symptoms and Signs	Suspected Diagnosis	Confirmatory Diagnosis
Left ventricular failure	Dyspnoea, orthopnoea, fatigue, peripheral oedema, crackles on auscultation	History of heart disease, symptoms of congestion	Chest X-ray, echocardiography, ECG, arterial blood gas analysis
Pulmonary hypertension	Dyspnoea, fatigue, syncope, cyanosis	History of lung or heart disease, respiratory symptoms	Chest X-ray, echocardiography, cardiac catheterisation, pulmonary function tests
Cardiomyopathy	Fatigue, dyspnoea, palpitations, peripheral oedema, chest pain	History of chronic heart symptoms	Chest X-ray, echocardiography, cardiac MRI, ECG
Pericardial effusion	Dyspnoea, chest pain, jugular venous distension, muffled heart sounds	History of infectious or inflammatory disease	Chest X-ray, echocardiography, chest CT
Atrial septal defect	Dyspnoea, fatigue, palpitations, cyanosis in severe cases	History of heart murmur, heart failure symptoms	Chest X-ray, echocardiography, cardiac catheterisation
Mitral stenosis	Dyspnoea, fatigue, palpitations, haemoptysis, orthopnoea	History of rheumatic fever, heart symptoms	Chest X-ray, echocardiography, ECG
Left ventricular aneurysm	Dyspnoea, chest pain, fatigue, palpitations	History of myocardial infarction, heart symptoms	Chest X-ray, echocardiography, cardiac MRI, chest CT
Mediastinal emphysema	Dyspnoea, chest pain, subcutaneous crepitations	History of chest trauma or invasive procedures	Chest X-ray, chest CT
Hiatal hernia	Abdominal pain, gastroesophageal reflux, dyspnoea	History of gastrointestinal symptoms	Chest X-ray, chest CT, barium swallow study
Other causes	Vary depending on the aetiology, may include dyspnoea, chest pain, fatigue, weight loss	Clinical history and relevant background	Chest X-ray, chest CT, echocardiography, biopsy if tumours are suspected