ABSTRACT
Making the correct diagnosis in cases of congenital heart disease has always been challenging. This is especially true at the viewbox when one has only a chest radiograph and some limited clinical information (cyanotic or not cyanotic) to go on. Careful analysis of many factors including assessment of the pulmonary vascularity (increased, normal or decreased), size and position of the aorta, aortic knob, pulmonary artery and left ventricle is essential. Larry Elliott 1 (University of Florida in 1968), credited a former teacher, Lewis Carey (University of Minnesota), for the analogy of an enlarged left ventricle to one of Al Capp’s ‘Shmoos’. ‘The left ventricular configuration is remembered more easily by the beginning student if it is considered or likened to Al Capp’s ‘Shmoo.’ 1 When left ventricular enlargement is combined with an ectatic ascending aorta, especially in the setting of aortic insufficiency, the Shmoo-shaped heart is most evident (Figures 1 and 2), in this author’s opinion. Cardiac shapes with either ventricular hypertrophy or ventricular enlargement were originally associated with the variable shape of a shmoo and are illustrated in the book 1 . ‘Drawing of ‘Shmoo’ on PA film in patient with left ventricular enlargement. This was done through the courtesy of Al Capp to dramatize the likeness of left ventricular disease to the configuration of the Shmoo.’ Reprinted from <italic>X-ray Diagnosis of Congenital Cardiac Disease</italic> by Elliott and Schiebler (1968)’, with permission of Charles C Thomas, Publisher, Springfield,ll https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9781003076568/34c29fd5-5662-4e8f-b58c-badd7fa5d724/content/fig78_1_B.jpg"/> One of Al Capp’s Shmoos. Reprinted with permission from <italic>The Life and Times of the Shmoo</italic> by <xref ref-type="bibr" rid="ref78_3">Capp (1949)</xref>’, published by Pocket Books. New York. © Capp Enterprises Inc. All rights reserved https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9781003076568/34c29fd5-5662-4e8f-b58c-badd7fa5d724/content/fig78_2_B.jpg"/>
