Differential Diagnosis for Cardiac Enlargement with Preferential Contrast in the Right Heart
- Single most likely diagnosis:
- Pulmonary embolism: This condition is likely given the preferential contrast in the right heart and the mild thickening of the anterior margin of the pulmonary outflow tract, which could indicate increased pressure or strain on the right ventricle.
- Other Likely diagnoses:
- Congenital heart disease (e.g., atrial septal defect, ventricular septal defect): These conditions can lead to right heart enlargement due to increased volume load.
- Pulmonary hypertension: This can cause right ventricular hypertrophy and enlargement, which might explain the preferential contrast in the right heart.
- Tricuspid regurgitation: Valve dysfunction can lead to right ventricular enlargement and might be associated with the observed findings.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Pulmonary thromboembolism with pulmonary infarction: Although similar to pulmonary embolism, the presence of infarction could significantly alter management and prognosis.
- Cardiac tamponade (despite no pericardial thickening): The absence of pericardial thickening does not rule out tamponade, especially if there's a recent or acute process involved.
- Right ventricular myocardial infarction: This could present with right heart enlargement and dysfunction, and is critical to diagnose due to its implications for management.
- Rare diagnoses:
- Arrhythmogenic right ventricular cardiomyopathy (ARVC): A rare condition characterized by fibrofatty replacement of the right ventricular myocardium, leading to enlargement and dysfunction.
- Uhl's anomaly: A rare congenital heart disease characterized by near-total absence of the right ventricular myocardium, leading to significant right heart enlargement.
- Ebstein's anomaly: A congenital defect of the tricuspid valve and right ventricle, which can result in right heart enlargement and dysfunction.