CXR Case 125

There is a calcified, unfolded aorta and large hiatus hernia.
The trachea is slightly deviated to the right.
Both costophrenic angles are obscured and there is a trace of fluid in the horizontal fissure.

None of these signs are likely to account for the clinical presentation, although it would be worthwhile exploring symptoms of heart failure (and perhaps arrhythmia).

This is a good example of a very prominent finding on an X-Ray distracting the reader from more subtle findings – stick to your routine despite what you find!