The limitations of the radiograph for detecting early heart enlargement

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Abstract
The difficulties of detecting early enlargement of the heart are considerable, and the cardiothoracic ratio is unsuitable for this purpose, but relatively slight enlargement may be detected if a pre-existing radiograph is available. In normal persons the difference in the transverse diameter of the heart in three radiographs taken on separate occasions was 1·5 cm or less in a very large majority of subjects. Enlargement of 2 cm or more between two radiographs will therefore indicate a high probability that the enlargement is pathological.

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