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What is the abnormality on this chest X-ray?
Cardiomegaly. An abnormal left cardiac contour, with a focal bulging of the left ventricular outline.
What is the differential diagnosis?
The differential is broad and includes left ventricular aneurysm or masses abutting the heart / pericardium.
How would you further assess this patient?
Echocardiography initially. Cardiac CT may then be used to further assess.
Mildly rotated to the left. Median sternotomy wires noted. There is cardiomegaly without evidence of pulmonary oedema. The left cardiac contour is abnormal, with a large focal prominence projecting laterally. The lungs and pleural recesses are clear.