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What are the main causes of this?
Cardiomegaly (from a variety of reasons), pericardial effusion, and very rarely cardiac tumours.
What is the best test for assessing pericardial effusion?
(1) Rapidly enlarging cardiac silhouette compared to previous imaging, or if not available (2) echocardiography.
Even on this projection the cardiac silhouette is enlarged. No focal consolidation. Small left pleural effusion.