Gross enlargement of cardiac outline due to pericardial effusion.
In this case there was underlying severe right ventricular endomyocardial fibrosis as well.
Differential diagnosis of gross enlargment of cardiac size on x-ray include:
1. Large pericardial effusion
2. Ebsteins’s anomaly of tricuspid valve
3. Multivalvular heart disease
4. Endomyocardial fibrosis