Q. A 36-year-old male presents with a headache that has been on and off for several years. The headaches have been frequent and were diagnosed as migraines last year, for which the medication he was prescribed has not been of any benefit. The patient’s blood pressure has been found significantly elevated on several occasions. His past medical history and family history is unremarkable. He does use tobacco, illicit drugs, or consume alcohol. On examination, his blood pressure is 185/105 mmHg, heart rate 90/min, and respiration rate 18/min. Chest auscultation reveals clear lung fields. A 4th heart sound is audible in addition to a continuous murmur that is heard in multiple areas on the chest. Which of the following is a possible finding on chest x ray?