mild cardiomegaly

[lindalilley]

My husband is a healthy 59 yo white male.  He has had a year of minor health issues such as two bulging disks and a chronic hives situation so that in the last year he has had about 4-5 prednisone packs and several injections of kenalog (IM) for the hives and then 2 epidural steroid injections over a 6-8 month time frame.   Because of the itching/hives, we have had several lab panels/profiles taken and ALL lab work to this point has been found to be WNL.  All liver/renal/hematological etc....all WNL and all chemical profiles as well are within normal limits.  He had a chest xray done as part of his annual exam and the chest pa and lateral states:

As compared to the prior study done on 3/29/1999:
The heart appears minimally enlarged.  The cardiac size appears slightly greater than on the prior study.  There is no vascular congestion.  The lungs are clear of infiltrates.  There is no evidence of pleural fluid.  There is an azygous lobe.  IMPRESSION:  Minimial cardiomegaly.  The heart size appears to have increased slightly since 3/29/1999.  No acute finidngs.

The internist sent the report to us as he does with all our diagnostic studies/lab work etc so that we keep them for our files.  This xray was done on April 3, 2008.

Is there a cause for concern here?  We will be following up with the internist on April 30th 2008.  Could the weight gain (some 20 pounds) and prednisone/steroids have contributed to this?  There is a maternal history (his mother) of aortic stenosis that was diagnosed when she was 84 yo and she just recently passed about 4 weeks ago at the age of 94 due to long term CHF secondary to the severe!!! aortic stenosis.  In looking at her history, her father and one of her sisters both had some sort of "cardiac condition" altho we do know that the sister was also diagnosed with aortic stenosis at the age of 83.

Being a nurse and prepared as a Ph.D. in nursing I want to be sure that we aren't missing anything here or "downplaying" the chest xray.  Your thoughts???????
Thanks
LLL

[kenkeith]

QUOTE:
"As compared to the prior study done on 3/29/1999:
The heart appears minimally enlarged.  The cardiac size appears slightly greater than on the prior study.  There is no vascular congestion.  The lungs are clear of infiltrates.  There is no evidence of pleural fluid.  There is an azygous lobe.  IMPRESSION:  Minimial cardiomegaly.  The heart size appears to have increased slightly since 3/29/1999.  No acute finidngs."
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Of interest what is the underlying cause for the minimally enlarged heart.  As you probably know it is an estimate and may be within the normal dimension range when margin of error is considered.

Cardiomegaly due to dilation (usually the left ventricle) and may enlarge to compensate or overcompensate for increased afterload. Cardiomegaly due to left ventricular or/and RVH. Those enlargements can be due to heart muscle disease, etc.

I suspect the slight enlargement issue is not significant and everything else appears to be within expected and acceptable terms.  I'm not sure if steriods and the other medication can effect a heart enlargement, but if the medication is the cause, it may be similar to alcohol and effect the heart muscle?!