An Observational Data Analytical Research on Pediatric Cardiomegaly as a Predictor of Structural or Functional Heart Diseases: Chest X-Ray Versus Echocardiography Comparison and Contemplation

Abstract

Background: Chest X-ray (CXR) is a routine, noninvasive test advised in a plethora of pediatric non-cardiac conditions such as bronchopneumonia, respiratory distress, failure to thrive, suspected tuberculosis, and for preoperative anesthesia clearance. Finding of cardiomegaly (CM) on CXR is a common cause of referral to a pediatric cardiologist. The question lies in its significance: whether CM in CXR corroborates with cardiac disease (s), structural or functional. Materials and Methods: The data of 229 children (median age: 6 months), referred to pediatric cardiology unit for echocardiography with CXR depicting CM over a period of 2 years (June 2019 to July 2021), were retrospectively reviewed. Clinical and laboratory findings, CXR, and echocardiography were analyzed for all children to determine the positive predictive value of CM in CXR to detect cardiac disease. Echocardiography was taken as gold standard to reach the cardiac diagnosis. Results: True CM was noted in 85% (Group A), whereas 15% had false CM (Group B). Group A comprised structural heart defect in 71.7% and ventricular dysfunction in 13.3%. Less common causes were severe anemia, hypertensive heart failure, arrhythmogenic cardiomyopathy, diphtheritic cardiomyopathy, multisystem inflammatory syndrome in children, pericardial effusion, thiamine deficiency, and severe idiopathic pulmonary arterial hypertension. In Group B, the most common reasons for false diagnosis were expiratory film (n = 18), thymic shadow (n = 12), and chest deformity and mediastinal mass (n = 2 each). Conclusion: CM in CXR strongly correlates with cardiac involvement and has a high positive predictive value. Combining clinical, laboratory, and CXR interpretation enables the pediatrician to achieve a rapid functional diagnosis. Medical stabilization can be initiated with this knowledge pending the availability of echocardiography in resource-limited areas. Detailed evaluation at a pediatric cardiac center should be completed to reach a final diagnosis in all such patients. In the absence of congenital heart disease, known acquired causes leading to cardiac compromise should be actively looked for.