Some of the findings are quite obvious while some are subtle. It is an early post operative X-ray after prosthetic aortic valve replacement. The prosthetic valve ring is very difficult to make out as it is not a well penetrated film for that purpose. Bilateral pleural effusion is quite obvious. The internal jugular central venous line is also quite obvious. Sternal suture wires are also easy to make out. The stapler pins used for skin closure are visible on close scrutiny near the midline. The stapler pins and presence of central line indicates that it is an early film after the open heart surgery for aortic valve replacement.