FastTrack Complete Report: Follow-up Assessment for Congestive Heart Failure (CHF)

Table of Contents

1. Purpose & Use – Case Type
2. Clinical Status Options
3. X-RAY Signals to Be Assessed
   A. Cardiovascular Findings
   B. Pulmonary Patterns
4. Follow-up Scenarios & Recommendations

1. Purpose & Use – Case Type

This FastTrack Complete Report is intended for the re-evaluation of patients with a prior diagnosis of pulmonary changes and/or cardiomegaly consistent with congestive heart failure (CHF). It is designed to assess whether the previously noted radiographic abnormalities have resolved, improved, or progressed, thereby assisting in clinical decision-making, treatment adjustment, and ongoing patient management.

Scenarios when to use this FastTrack Complete Report:

• The patient has a known history of cardiac disease or CHF.
• There are previous radiographs showing cardiomegaly and/or pulmonary abnormalities such as evidence of pulmonary edema or effusion.
• The current imaging is for monitoring response to treatment, such as after initiation or adjustment of diuretics or other cardiac medications.
• Clinical concern exists for persistent or worsening respiratory signs or evidence of acute decompensation.
  
   

2. Clinical Status Options (Submitter to Select One)

The clinical status of the patient helps contextualize the radiographic findings and guide interpretation relative to the patient’s clinical course:

• Resolved: All clinical signs have resolved, and the patient is considered stable.
• Improving: Clinical signs are decreasing in both severity and frequency, indicating a positive response to therapy.
• Persisting / Worsened: Clinical signs remain unchanged or have progressed, suggesting limited or no therapeutic response.
• Signs of Distress: Evidence of respiratory compromise or acute decompensation requiring urgent clinical attention.

3. X-RAY Signals to Be Assessed

The FastTrack Complete Report focuses on key radiographic features that are clinically relevant to the patient’s presenting signs, with the goal of determining whether previously noted abnormalities have resolved, improved, or persisted/worsened. The following radiographic signals are systematically evaluated to identify changes that may warrant immediate clinical attention, additional diagnostic assessment, or adjustment/discontinuation of current therapy.

A. Cardiovascular Findings

• General Cardiomegaly 
• Left Atrial Enlargement 

B. Pulmonary Patterns

• Caudodorsal Parenchymal Pattern 
• Cranioventral Parenchymal Pattern 
• Diffuse Parenchymal Pattern 
• Pleural Fluid 

4. Follow-up Scenarios & Recommendations

A. Resolved

Findings:
Complete resolution of previously noted pulmonary infiltrates, vascular congestion, or pleural effusion.

Recommendations:

• Continue current cardiac medication regimen.
• Routine clinical monitoring advised.
• No further imaging needed unless clinical signs recur.

B. Improving

Findings:
Decreased pulmonary edema, reduced vascular congestion, partial resolution of pleural effusion.

Recommendations:

• Maintain current medical therapy (e.g., diuretics, ACE inhibitors).
• Repeat imaging only if clinical signs persist or as part of a scheduled follow-up.
• Continue monitoring respiratory rate and effort at home.
   

C. Persisting / Worsened

Findings:
Persistent or progressive pulmonary infiltrates, vascular congestion, and/or pleural fluid. Potential increase in cardiac silhouette size.

Recommendations:

• Re-evaluate current cardiac treatment.
• Consider dose adjustments or addition of further therapy.
• Additional diagnostics (e.g., echocardiogram, NT-proBNP)
• Emergency stabilization (e.g., oxygen therapy) if warranted.
• Hospitalization may be necessary in acute or unstable cases.

D. Signs of Distress

Findings:

Radiographic evidence consistent with acute decompensation, including severe pulmonary edema, marked cardiomegaly, large volume pleural effusion.

Recommendations:

• Immediate clinical intervention is recommended.
• Stabilization (oxygen, diuretics), advanced diagnostics, and potential referral to cardiology.
• Serial imaging may be needed to monitor response.