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Small cardiothoracic ratio

Case contributed by Mostafa Elfeky
Diagnosis almost certain

Presentation

Chest pain.

Patient Data

Age: 16 years
Gender: Female
x-ray

Apparently small size of the heart, with a decreased cardiothoracic ratio (9/26=0.35).

x-ray

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.

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