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today were going to discuss the findings of congestive heart failure this is a chest x-ray on the patient who is at baseline there is no clinical symptoms of pulmonary edema such as shortness of breath paroxysmal nocturnal dyspnea or evidence of congestive heart failure we see that the heart size is normal the pulmonary vessels are sharply margin ated and that they are normal in calibre notice the costophrenic angles this salsa are sharp and we do not see any curly lines these findings indicate that this is a normal chest x-ray without evidence for congestive heart failure he returns to us now with shortness of breath and pedalled edema and we notice first that the heart has markedly increased in size since the prior study if you look carefully we could even see that the left atrium which is this opacity sitting under the Carina is enlarged of particular interest I think is the caliber of the upper lobe vessels we call this vascular redistribution or cephalization there is distension