This X-ray is suggestive of:
a) Multivalvular heart disease
b) Pericardial effusion
c) Ebstein’s anomaly of tricuspid valve
d) None of the above
Answer: b) 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
In pericardial effusion the shadow is globular with no lobulations. In valvular heart disease different bulges in the cardiac contour will be seen due to asymmetric enlargement of various cardiac chambers. In Ebstien’s anomaly of tricuspid valve and endomyocardial fibrosis, it is mainly right atrial enlargement (including atrialized portion of right ventricle in Ebstein’s anomaly). An example of cardiomegaly not due to pericardial effusion: http://cardiophile.org/2010/09/gross-cardiomegaly-on-cxr/