Pulmonary edema on chest X-ray supine view: Supine view is identified by the absence of fundal gas bubble below the diaphragm. Moreover, the scapulae are seen within the lung fields, which will not be there in a well positioned chest X-ray PA view. The apparent cardiomegaly cannot be commented upon since it is a supine view. Haziness of the lung fields are due to fluid in the alveoli (pulmonary edema). Now-a-days detection of B lines or ultrasound lung comets on bedside point-of-care ultrasound can diagnose pulmonary edema fairly well.
Standard chest X-ray PA view is taken with the patient standing behind the X-ray film and the X-ray tube at a distance of 72 inches behind. At that distance, the X-ray beam is somewhat parallel and does not produce magnification of the heart as viewed from the X-ray film. In supine view the heart is more away from the X-ray film and usually the X-ray tube is much nearer to the person, producing magnification of the cardiac outline. In this era of digital X-rays, it may be noted that the image acquiring cassette does not have a film, but a sensor instead. Image is then transferred to the console for either viewing in a computer screen or printing on a film (usually of much smaller size than the conventional chest X-ray film).
A repeat chest X-ray after treatment of the left ventricular failure which caused the pulmonary edema showed complete clearance of the pulmonary congestion.