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Severe calcification of the aortic valve leaflets in aortic stenosis is difficult to visualize on a chest 21 radiograph and can sometimes be identified on the lateral view. A, Lateral chest radiograph of elderly patient with severe aortic stenosis shows an irregular, ringlike calcification (arrow) in the expected location of the aortic valve. The location corresponds with the abnormality seen on the lateral chest radiograph. Coned-down images of the frontal (C) and lateral (D) chest radiographs obtained after transcatheter aortic valve replacement display the location of the valve replacement. Note that dark windowing of the images may be required to better visualize metallic hardware and calcifications. The marked convexity of the right cardiac border is caused by the extremely dilated right atrium. The right ventricle is also much enlarged, as evidenced by the left lateral displacement of the right location of the tip of the ventricular lead of the cardiac pacemaker, which is located in the right ventricle. Marked enlargement of the main pulmonary artery contour (long arrow) and overall enlargement of the heart result from an enlarged right ventricle and right atrium, in keeping with the severe pulmonary hypertension. Central pulmonary arteries in the hila are enlarged, with multiple smaller arterial branches peripheral to the hila indicating shunt vascularity (short arrow). The inferior vena cava contour is displaced posteriorly because of the right atrial dilation. Dilated peripheral arterial branches extend to the pleura because of shunt vascularity. The left ventricle and left atrium are enlarged, resulting in an overall enlargement of the cardiac silhouette, displacement of the cardiac apex leftward and toward the diaphragm, and flattening of the upper left cardiac border. In the setting of a shunt, the receiving cardiac chamber or vessel becomes enlarged.

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9 of 10 - Review by F. Steve
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