Figure 5-115.

Congestive heart failure: Ejection fraction of less than 15% and mild pericardial effusion.

This 45-year-old male with a history of hypertension reported chronic dyspnea, worse in the last week. His blood pressure was 190 systolic with bilateral lower extremity edema. Although his cardiac silhouette is enlarged, his diaphragm and heart borders are clear without evidence of pleural effusions. His superior pulmonary vascular markings are increased, a finding called cephalization that is an early marker of increased pulmonary vascular volume and heart failure. An echocardiogram was preformed, showing global hypokinesis with an ejection fraction of less than 15%—decreased from 45% on echocardiogram 3 years prior. Only a mild pericardial effusion was seen, indicating that the majority of the increased heart size seen on x-ray is due to true cardiomegaly.