Cardiomyopathy

Pathophysiology:  The cardiomyopathes can be classified as (1) congestive/ischemic (2) restrictive  (3) hypertrophic.  The commonest is congestive cardiomyopathy of ischemic etiology.

CXR Findings:

1. enlarged, somewhat globular cardiac silhouette (>> 2:1) with multiple chamber dilation
2. pulmonary congestion or pleonemia
3. associated pulmonary edema

"Aunt Sophies":

1. pericardial effusion
2. rheumatic heart disease with multiple valve involvement
3. rarely, pericardial cysts, pericardial tumors, various congenital heart disease (eg. Ebstein's anomaly in an adult)

A pericardial effusion is the commonest mimicker of congestive cardiomyopathy and the classic plain CXR "fat-stripe" sign is rarely seen.  Echocardiography (or CT) is required to prove the presence of a pericardial effusion.