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Enlarged Inferior Vena Cava, Right Atrium
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Enlarged Inferior Vena Cava, Right Atrium

Dear Doc,

I've written before regarding a CT scan that showed a sligthly enlarged inferior vena cava, right atrium, top normal liver and prominent splenic vein.  An echo confirmed the slightly enlarged right atrium, and indicated that my left ventricle and atrium have also enlarged by approximately 25% since the last echo 6 months ago.  The echo also indicated a slight increase in mitral valve regurgitation.  I have been fatigued for a couple of years, have run a low grade fever, have been told that I have symptoms of endocarditis (petechaie, splinter hemorrhages, hematuria, LUQ and flank pain, in addition to fever), but that has been ruled out because of the duration of my symptoms and negative blood cultures and echoes.  No one can figure out what is going on with me, specifically of concern now, the causes for the enlargements described above. There doesn't appear to be any lung congestion, and the valve regurgitation is not severe enough to explain the enlargement.  Do you have any thoughts or suggestions on other possible causes of enlargement, and if there are any additional studies that could be conducted that may provide some insight?

Thank you for your time and input.

Ch

Oh, I'm a 40 year old female, don't smoke, or drink more than a few drinks a week, and I exercise regularly.
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Dear ch,
I don't really know what would be causing this.  I would probably order an MRI to exclude fatty infiltration of the wall of the heart.  In addition they should probably check the blood flow to the heart with a persantine thallium.  If these are both unhelpful in making a diagnosis then my recommendation would be to proceed to a heart biopsy.  It is not normal for your heart to continue to enlarge like this and the cause must be found so that treatment (if any needed) can be started.
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