38/40 neonate. Normal pregnancy and antenatal ultrasound. Respiratory distress.
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The cardiac contour is massively widened with a CTR over 80%. Despite cardiomegaly, there is no pulmonary venous prominence, air-space consolidation, interstitial fluid or pleural effusion.
The picture here is of massive cardiomegaly in a term neonate with respiratory distress, but no evidence of overload (no alveolar or interstitial edema, or pleural effusion).
While the vast majority of neonates with this degree of cardiomegaly, will have a structural cardiac defect, the lack of secondary signs point to a narrower differential that includes neonatal cardiomyopathy.