Which finding on chest X-ray may indicate left-sided heart failure?

The presence of cardiomegaly and pulmonary edema on a chest X-ray is indicative of left-sided heart failure. In left-sided heart failure, the heart's ability to pump blood efficiently is compromised, which leads to a backlog of blood in the pulmonary circulation. This backlog can cause fluid to leak into the lung interstitium and alveoli, resulting in pulmonary edema.

Additionally, cardiomegaly, or enlargement of the heart, can occur due to the increased workload placed on the heart over time from conditions such as hypertension or valvular heart disease, both of which are contributors to left-sided heart failure. When these two findings are observed together on a chest X-ray, they provide strong evidence of the condition.

The other options suggest different pathologies. For example, pleural effusion, while it can occur due to left-sided heart failure, is not as specific as cardiomegaly and pulmonary edema for diagnosing the condition. Consolidation typically indicates a lung infection like pneumonia, whereas hyperinflation suggests chronic obstructive pulmonary disease or asthma, conditions unrelated to heart failure. Thus, cardiomegaly and pulmonary edema are hallmark radiographic findings that specifically point to left-sided heart failure.