​Symptoms and Signs – Differential Diagnosis of Cardiac Enlargement
CARDIAC CHAMBER ENLARGEMENT
• Chronic volume overload: mitral or aortic regurgitation, left-toright shunt (patent ductus arteriosus [PDA], ventricular septal defect [VSD], arteriovenous [AV] fistula)
• Cardiomyopathy: ischemic, nonischemic
• Decompensated pressure overload: aortic stenosis, hypertension
• High-output states: severe anemia, thyrotoxicosis
• Bradycardia: severe sinus bradycardia, complete heart block

LEFT ATRIUM
• Left ventricular (LV) failure of any cause
• Mitral valve disease
• Myxoma

RIGHT VENTRICLE
• Chronic LV failure of any cause
• Chronic volume overload: tricuspid or pulmonic regurgitation, left-to-right shunt (atrial septal defect [ASD])
• Decompensated pressure overload: pulmonic stenosis, pulmonary veno-occlusive disease, pulmonary artery hypertension: primary, secondary (pulmonary embolism [PE], chronic obstructive pulmonary disease [COPD])

RIGHT ATRIUM
• Right ventricular (RV) failure of any cause
• Tricuspid valve disease
• Myxoma
• Ebstein’s anomaly

MULTICHAMBER ENLARGEMENT
• Hypertrophic cardiomyopathy
• Acromegaly
• Severe obesity

PERICARDIAL DISEASE
• Pericardial effusion with or without tamponade
• Effusive constrictive disease
• Pericardial cyst, loculated effusion

PSEUDOCARDIOMEGALY
• Epicardial fat
• Chest wall deformity (pectus excavatum, straight back syndrome)
• Low lung volumes
• Anteroposterior (AP) chest radiograph
• Mediastinal tumor, cyst