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This case report describes the disparity between the findings of the plain chest film and the echocardiogram in a patient with severe coronary artery disease. Whereas the plain chest film shows a normal cardiothoracic ratio of 50% indicating normal LV size, the echocardiogram shows features characteristic of a dilated cardiomyopathic left ventricle with low amplitude of wall motion and consequently low ejection fractoin. These echocardiographic findings were confirmed at cardiac catheterization and angiography. We propose the use of echo instead of the plain chest film in the evaluation of LV size in the cardiac patient.
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