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Echocardiography and enlarged cardiothoracic ratio
The Guys’ and St Thomas’s echo team are to be congratulated on producing evidence-based advice that could result in a significant reduction in cardiac ultrasound referrals, which may be enhanced if our radiology colleagues are taken on board.1 Many years ago, our echo department was overloaded with requests for studies as a consequence of radiology reports that included the emotive term ‘cardiomegaly’. This expression is, of course, speculative, as enlargement of the ‘cardiac’ shadow may be due to an expiratory radiograph, prominent epicardial fat pads, pericardial effusion or even an anterior mediastinal mass.2 I managed to get our radiologists to use the alternative term ‘cardiac silhouette’ (as in ‘the cardiac silhouette is slightly enlarged’). Referrals plummeted.
Nigel I Jowett
Consultant Physician and Cardiologist
Hywel Dda University Health Board, Fishguard, Pembrokeshire
1. Wingate-Saul L, Javaid Y, Chambers J. Echocardiography is not indicated for an enlarged cardiothoracic ratio. Br J Cardiol 2013;20:149–50. http://dx.doi.org/10.5837/bjc.2013.30
2. Novelline RA. Squire’s fundamentals of radiology. Harvard: Harvard University Press, 2004.