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There is cardiomegaly with a prominent ascending thoracic aorta and calcification in the region of the aortic valve. There is upper lobe blood diversion consistent with mild left ventricular failure.

Causes of aortic stenosis include congentital stenosis, a bicuspid aortic valve, rheumatic heart disease and senile calcific valve degeneration. The gradient across the heart valve produces left ventricular hypertrophy with increased muscle mass which can cause relative myocardial ischaemia and the risk of cardiac arrhythmias. If untreated, left ventricular decompensation leads to left ventricular dilatation and pulmonary venous congestion.

The X-ray findings include, post-stenotic dilatation of the aorta, calcification of the aortic valve and a left ventricular configuration seen at the left heart border with concavity along the mid-lateral border and increased convexity along the lower left heart border (Table 1.3).

Table 1.3 Causes of cardiomegaly

■ Ischaemic heart disease

■ Valvular heart disease

■ Congenital heart disease

■ Dilated cardiomyopathy

■ Pericardial effusions

In left ventricular hypertrophy from hypertension or aortic stenosis, the cardiac silhouette does not dilate until late in the natural history.

Fig. 1.38 Enlarged heart. Cardiomyopathy - note the globular appearance. The differential diagnosis included pericardial effusion.

Man admitted with acute chest pain. Report this film (Fig. 1.39).

Fig. 1.39 Quiz case.

Man admitted with acute chest pain. Report this film (Fig. 1.39).

■ What is the most common cause?

Fig. 1.39 Quiz case.

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