A female of 40 years presenting with intolerance to cold, constipation and hoarseness of voice was found to have cardiomegaly on chest roentgenogram. Which of the following investigations is the best to determine the cause of her cardiomegaly?
Correct Answer: Echocardiography
Description: Ans. d. Echocardiography (Ref: Harrison 19/e p270e-1, 18/e p1842, 1843Echocardiography is the best investigation to determine the cause of cardiomegaly.EchocardiographyProduces high-resolution tomographic images of cardiac structures and their movements.Qualitative and quantitative measurements of cardiac dimensions, area, and volume are derived from two- dimensional images or M-mode recordings derived from two-dimensional images.Principle:Ultrasound reflection of cardiac structures to produce images of the heart.Transesophageal echocardiography (TEE)Transthoracic Echocardiogram (TTE)* In selected patients, a transesophageal echocardiogram (TEE) may be performed, in which an ultrasound transducer is mounted on the tip of an endoscope placed in the esophagus and directed toward the cardiac structures.* Clinical Uses of TEE:* Inadequate transthoracic imagesQ* Aortic disease* Infective endocarditisQ* Source of embolismQ* Valve prosthesisQ* IntraoperativeQ* For a transthoracic echocardiogram (TTE), the imaging is performed with a handheld transducer placed directly on the chest wall.* A limitation of TTE is the inability to obtain high- quality images in all patients, especially those with a thick chest wall or severe lung disease, as ultrasound waves are poorly transmitted through lung parenchyma. Clinical Uses of 2D EchocardiographyChamber Size and Function* Ideal imaging modality for assessing left ventricular (LV) size and function.* Useful in the diagnosis of LV hypertrophy* Imaging modality of choice for the diagnosis of hypertrophic cardiomyopathy.Valve Abnormalities* Gold standard for imaging valve morphology and motion* Gold standard for the diagnosis of mitral stenosisPericardial Disease* Imaging modality of choice for the detection of pericardial effusionIntracardiac Masses* LV thrombus appears as an echo-dense structure, usually in the apical region associated with regional wall motion abnormalities* Vegetations appear as mobile linear echo densities attached to valve leaflets.* Atrial myxoma can be diagnosed by the appearance of a well-circumscribed mobile mass with attachments to the atrial septum* The high-resolution images provided by TEE may be required for further delineation of myocardial masses, especially those <1 cm in diameter.Aortic Disease* Definitive diagnosis of a suspected aortic dissection usually requires a TEECongenital Heart Disease* Congenital stenotic or regurgitant valve lesions can be assessed.* Detection of intracardiac shunts* Patency of surgical shunts and conduitsEchocardiography has become an ideal imaging modality for cardiac emergencies.The high-resolution images provided by TEE may be required for further delineation of myocardial masses (tumour or thrombus), especially those <1 cm in diameter.Technology such as harmonic imaging and IV contrast agents (which traverse the pulmonary circulation) can be used to enhance endocardial borders in patients with poor acoustic windows.
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