A rectangular (quadrangular) heart.

We report a case of "rectangular (quadrangular) heart" seen on the chest X-ray. Full evaluation showed massive enlargement of right-sided chambers shadowing the left-sided chambers. Primary etiology of the right-sided failure was attributed to severe mitral and tricuspid regurgitation for which the patient underwent surgery. <Learning objective: To understand that a cardiac chamber enlargement can result in massive increase in cardiac silhouette on a chest X-ray. Predominant right atrial and ventricular enlargement in comparison to left-sided chambers can give rise to a peculiar shape (rectangular/quadrangular) in the chest X-ray.>.