This chest X ray taken during a barium swallow shows right ventricular enlargement, a small pulmonary trunk, increased pulmonary arterial vascularity and a left aortic arch.
Right ventricular enlargement is demonstrated by the upturned cardiac apex. Decreased size of the pulmonary trunk is suggested by the straight left cardiac silhouette. Increased pulmonary arterial vascularity is reflected by dilated central pulmonary arteries. A left aortic arch is indicated by deviation of the tracheal air shadow to the right and presence of the aortic knob at the left upper mediastinal border.