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39 patients with enlarged cardiac size based on cardio-thoracic ratio on chest X-ray underwent echocardiographic assessment. 29 male patients and 10 femalepatients were included In this study during a period of ten months in the year 2002. The median age was 51.0 years. Measurement of left ventricular enlargement based on the criterion developed by Devereux (1987) showed that 44.8% of males and 30.0% of females (total 41%) had enlarged left ventricular mass per square meter of body surface who had enlarged cardiac shadows based on CT ratio measured on chest X-ray. According to the criterion set by American College of cardiology (1983) showed that only 51% of the total subjects who had enlarged cardiac size in chest radiography were found to have enlarged left ventricle. When compared with the Normogram values, end diastolic volume, end systolic volume and left ventricular posterior wall as diastole showed 15.4%, 28.3%, 43.6% and 23.0% of the total patients having enlarged left ventricle, who were having enlarged cardiac size based on the chest radiography. These values are statistically insignificant to prove the validity of CT ratio used to diagnose enlarged cardiac size. A maximum of 51.3% and a minimum of 15.4% (average 33.5%) of the patients having enlarged cardiac size having no obvious radiographic markets on chest radiography of cardiac illness were proven to have cardiomegaly by various criteria using echocardiography. The left ventricular enlargement according to left ventricular mass by body surface area calculated by parameter specified by Devercux (1987) and American Collage of Cardiology (1983) had comparable values. Left ventricular size measured by systolic and diastolic volumes and wall thickness criteria had different values. Comparison of Plain X-ray finding of Ventricular Enlargement with Echocardiography