Presentation
Chest pain.
Patient Data
Apparently small size of the heart, with a decreased cardiothoracic ratio (9/26=0.35).
Normal cardiothoracic ratio (10.4/23=0.45).
Case Discussion
Commonly, abnormal cardiothoracic ratio refers to an increased ratio inferring cardiomegaly. In this case, there is a noticeably small ratio (0.35). A normal ratio is between 0.42 and 0.50.
The patient's hemoglobin level is 12 mg/dL excluding anemia and no psychological or eating abnormalities. So, a repeat chest radiograph was recommended before further laboratory assessment or echocardiography, which surprisingly appeared normal (0.45). The abnormal ratio was suggested to be due to Valsalva maneuver during the first exam.