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Table 4 Clinical signs of heart failure or cardiomegaly on chest X-ray: narrowing differential diagnoses by cardiac ultrasound to guide management/and respective management (video clips of a normal heart and for each pattern are available as Additional file 2)

From: Cardiac ultrasound in resource-limited settings (CURLS): towards a wider use of basic echo applications in Africa

Ultrasound image Effusion Dilated CMP Right-sided heart failure Valvular (mitral) LV Hypertrophy
Scanning method Subxiphoid view Optional: 4-chamber view Subxiphoid view Optional: 4-chamber view Subxiphoid view Optional: 4-chamber view, parasternal short Subxiphoid view Optional: 4-chamber view, parasternal long Subxiphoid view Optional: parasternal long
Key US features Anechoic fluid surrounding the hearta
In severe cases collapse of RV (tamponade)
Reduced inward movement of the LV wall
Generalized dilatation of both atria and ventricles
Dilated RV in comparison to the left (ratio > 0.7)
D-shaped LV in the parasternal short axis
Dilated LA
Thickened mitral valve
Mitral regurgitation on Doppler
Thickened LV (septum > 12 mm)
Dilated LA
Possibly secondary dilated right heart
Differential diagnosis TB
Massive fluid overload
Idiopathic dilated CMP (post-infectious)
Peripartum CMP
Alcoholic CMP
Ischemic heart disease (severe)
Pulmonary embolism
Pulmonary hypertension of other cause
Rheumatic heart disease Hypertension
Aortic stenosis
Genetic hypertrophic CMP
  1. RV right ventricle, LV left ventricle, LA left atrium, CMP cardiomyopathy, TB tuberculosis, HIV human immunodeficiency virus
  2. aUse the parasternal long axis to differentiate between pleural and pericardial effusions. Pericardial effusions continue anterior to the descending aorta, whereas pleural effusions are found posterior to the descending aorta