Which chest X-ray findings are commonly associated with congestive heart failure?

• A. Cardiomegaly
• B. Cardiomegaly, interstitial edema, pleural effusions
• C. Lobar consolidation
• D. Normal chest radiograph

Answer: (B)

Congestive heart failure raises pressures in the heart and lungs, leading to fluid backing up into the lungs and around the heart. On a chest X-ray the hallmark is an enlarged cardiac silhouette from dilation or volume overload, along with interstitial edema that shows as more prominent markings near the hila and other tissues (sometimes described as Kerley lines), and fluid accumulating in the pleural spaces as effusions. When these findings—cardiomegaly plus interstitial edema and pleural effusions—appear together, they fit the pattern most commonly seen with CHF. A lobar consolidation would point to pneumonia, and a normal radiograph can occur in early CHF but isn’t the typical picture of established congestive failure. So the combination described best reflects congestive heart failure.