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AimAbnormal cardiac size and shape on chest X-Ray (CXR) causes anxiety to paediatricians as it could be due to an underlying heart disease. We reviewed the echocardiogram findings of all children who were referred because of an incidental finding of an abnormal cardiac silhouette on CXR. None of these children had any abnormal signs or symptoms of a cardiac condition at the time of referral.MethodsRetrospective analysis of the patients whose data was prospectively collected over a 3 year period (Nov 2014-Oct 2017).Abstract G252(P) Table 1 No Age Indication for CXR Abnormality on CXR Echocardiogram result 1. 7 m Swallowed foreign body Cardiomegaly Normal 2. 1 day Sepsis Prominent aortic arch Normal 3. 14 y Cough ?Scimitar syndrome Normal 4. 4 m Fever and grunting ?Dextrocardia Normal 5. 9 y Asthma Prominent pulmonary trunk Normal 6. 4 m Chest infection Cardiomegaly Normal 7. 8 m Chest infection Cardiomegaly Normal 8. 14 m cough Cardiomegaly Small pericardial effusion ResultsEight patients were referred for echocardiogram and their details are given below (table 1).CXR was reported by paediatric radiologists for six children, adult radiologist for one child and consultant paediatrician for one child. CXR was done (P)o Anterior (PA) erect in three children, Antero (P)ior (AP) erect in one child and AP supine in 4 children. Only one echocardiogram was abnormal in a child in whom cardiomegaly was due to a small pericardial effusion that resolved spontaneously in a few weeks time. It is likely that this effusion was secondary to an underlying viral illness.ConclusionIncidental finding of an abnormal cardiac silhouette on a CXR in children with no underlying cardiac symptoms or signs is not associated with an underlying structural or functional heart disease.

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