Big case, with huge heatsinks, and big fans. Personally I have an Antec Fusion Remote MAX case, which fits a Noctua NH-D14. My graphics card is a little out of date, one of the fanless HD5750's, but it still plays everything I play at 1080p. I replaced the included tri-cool fans in the case with either Scythe (for the 120mm's) or Noctua (for the 140mm) fans. The heatsink fans use the two included voltage resistors, and the side 140mm and rear exhaust have 7V resistors. The front intake fan I believe has no resistor on it as doing so would affect coolling of the hard drives too much.
But you are correct. If you want to do this in a "small form factor" case, it just will not happen. That said, this case goes fine in my media/component rack, as it is no larger than my amplifier, or A/V pre-processor, and just a little larger than the Denon DVD player I have.
If you search in this forum for topics by me, I think I posted pictures a little while back.
System specs:
Intel i7-2600k cpu
MSI Z68a-GD80 motherboard
16GB DDR3 1600mhz RAM
Intel 120GB 510 series SSD
4x Western Digital 2TB Green hard drives
Blu-ray burner/HD-DVD player/DVD+/-RW combo drive
HD5750 passive video card
Antec Fusion Remote MAX case