What is the differential diagnosis?
One should consider the possibility of a pericardial effusion or even an anterior mediastinal mass, although in this case both would be most unlikely.
PA and lateral chest x-rays demonstrate markedly enlarged cardiac silhouette. There is a double contour to the right heart border and splaying of the carina.
The aorta is somewhat ectatic. There are no overt features of congestive cardiac failure at this time.