This diagnostic posteroanterior (PA) chest X-ray demonstrates the characteristic findings of Tetralogy of Fallot in a 21-year-old female patient. The image shows a well-centered view with adequate inspiratory effort. The primary finding is an increased cardiothoracic ratio with a distinctive 'boot-shaped' heart, also known as 'coeur en sabot.' This morphology is characterized by an upturned cardiac apex, resulting from significant right ventricular hypertrophy, and a concave pulmonary artery segment. The right heart border is notably prominent, indicating right atrial enlargement. Despite the history of surgical repair (including VSD closure and RV outflow tract reconstruction), these structural changes remain visible. The pulmonary vasculature appears normal, and the lung fields are clear without evidence of opacities, focal lesions, or pleural effusions. Sternal wires and surgical markers from prior cardiac procedures may be visible in the midline. The image serves as a classic educational example of chronic cardiac remodeling in congenital heart disease.

A posteroanterior (PA) chest X-ray of an adult male demonstrating classic radiological features associated with Tetralogy of Fallot (TOF). The cardiac silhouette exhibits mild cardiomegaly and a characteristic 'boot-shaped' heart (coeur en sabot). This morphology is defined by an upturned, rounded cardiac apex, indicating right ventricular hypertrophy, and a concave pulmonary artery segment (pulmonary conus). The lung fields appear relatively oligemic, reflecting decreased pulmonary blood flow typical of right-to-left shunting or pulmonary stenosis. No acute pulmonary infiltrates or pleural effusions are visible. The costophrenic angles are clear. This diagnostic image is intended for medical students and clinicians to identify visual markers of cyanotic congenital heart disease and right ventricular pressure overload in an adult clinical presentation.

This diagnostic image is an anteroposterior (AP) chest X-ray of a pediatric patient, specifically a 16-month-old male. The image demonstrates a classic 'boot-shaped' heart (coeur en sabot), a hallmark radiographic sign of Tetralogy of Fallot. The cardiac silhouette shows an upturned apex due to right ventricular hypertrophy and a concave main pulmonary artery segment. The lung fields exhibit increased, patchy opacities and markings, particularly prominent in the right lung, which may suggest compensatory pulmonary blood flow or associated bronchial anomalies. The mediastinum appears slightly shifted, and the overall lung volume is clear enough to evaluate the bronchovascular markings. This radiograph serves as a primary educational example of congenital heart disease (CHD) manifestations in pediatric radiology, illustrating the morphological changes to the heart and the secondary effects on pulmonary vascular distribution.

This diagnostic image is a posteroanterior (PA) chest X-ray of a pediatric patient demonstrating classic radiographic signs of Tetralogy of Fallot (TOF). The most prominent finding is a 'boot-shaped' heart (coeur en sabot), characterized by an upturned cardiac apex due to right ventricular hypertrophy and a concave pulmonary artery segment (pulmonary conus). The lung fields appear relatively oligemic, consistent with decreased pulmonary blood flow. The mediastinum is centrally located, and the diaphragm is well-defined, with the right hemidiaphragm slightly superior to the left. The skeletal structures show visible ribs and a vertebral column that appears to have mild alignment irregularities, potentially correlating with lumbar kyphoscoliosis mentioned in clinical context. The lower portion of the radiograph captures the upper abdomen, showing normal bowel gas patterns. This imaging is a classic educational example for pediatric cardiology and radiology, illustrating the morphological changes in the heart and great vessels associated with cyanotic congenital heart disease.