Chest radiology may show a normal sized or enlarged heart but with the apex above the diaphragm due to right ventricular hypertrophy and a concave left heart border because the main pulmonary artery is small. The cardiac silhouette has been likened to a wooden shoe (coeur en sabot). The lung fields are oligaemic, and the aortic arch may be seen on the right in up to half. Summarising the features: PA lateral
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