Cardiac silhouette size was measured using two methods. The first method was the vertebral heart score. The base apex length and craniocaudal length were transposed onto the vertebral column and recorded as the corresponding number of vertebrae measured from the cranial edge of T4 vertebral body. VHS more than 8 was considered enlarged and likely in heart failure. The base apex length was measured from the ventral wall of the carina to apex (orange solid line). The craniocaudal length was measured perpendicular to the base-apex length, at the widest width of the cardiac silhouette (green solid line). The second method used the base apex length and compared this against the length of sternebrae 2 to 4. If the length extended beyond three sternebrae, the cardiac silhouette was considered enlarged (dashed orange line). This patient has VHS of 9 and an elongated base-apex length suggestive of congestive heart failure