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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


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




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


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