A 64 year old man presented with shortness of breath and ankle swelling of many weeks duration.
His CXR showed cardiomegaly, bilateral perihilar haziness and upper lobe blood diversion. These are some of the signs of congestive cardiac failure.
Although CXR is of limited value in diagnosing CCF (echo is better), it remains the most important early tool in our work up of the patient. The radiographic findings may lag behind clinical symptoms where patients may have symptoms classical of CCF but there is no x-ray findings (by up to 12 hours). Similarly, the symptoms may resolve with treatment but the x-ray findings may persist for a few more days.
Pleural effusion may not be present, or be present bilaterally or unilaterally (most often on the right side).
The attached diagram here is a good summary of the CXR findings in congestive cardiac failure.