Left ventricular enlargement

Last revised by Yuranga Weerakkody on 4 Sep 2021

Left ventricular enlargement can be the result of a number of conditions, including:

Radiographic features

Plain radiograph

Features that may be visible on a chest radiograph include:


The parasternal long axis and apical four-chamber views on transthoracic echocardiography are often the primary views used to gain both a qualitative and quantitative appreciation of left ventricular enlargement.
Features include 4:

  • increased left ventricular internal end-diastolic diameter (LVIDd)
    • parasternal long axis LVIDd >5.3 cm (females) or >5.9 cm (males)
  • elevated left ventricular volumes
    • diastolic volumes >104 mL (females) or >155 mL (males)
    • systolic volumes >49 mL (females) or >58 mL (males)
  • increasingly spherical morphology
    • a normal left ventricle has prolate ellipsoidal morphology, with a long axis roughly twice that of the short axis
    • with severe LV enlargement the short axis dimensions may approximate those of the long axis, akin to a sphere

One publication has suggested left ventricular enlargement being able to be reliably identified on non-gated contrast-enhanced multidetector CT (with sensitivity of 78% and specificity of 100%) when the maximum luminal diameter of the LV is greater than 5.6 cm 5.

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Cases and figures

  • Figure 1: normal PA cardiomediastinal outlines
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  • Figure 2: diagram (frontal)
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  • Figure 3: diagram (frontal)
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  • Figure 4: diagram (lateral)
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  • Figure 5: diagram (lateral)
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  • Figure 6: Shmoo sign
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  • Figure 7: Hoffman-Rigler sign
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