This chest X ray taken during a barium swallo shows right ventricular enlargement, a small pulmonary trunk, decreased pulmonary arterial vascularity and right aortic arch.
Right ventricular enlargement is demonstrated by the upturned cardiac apex. Decreased size of the pulmonary trunk is suggested in this view by the straight upper left cardiac silhouette. These two findings create the so-called "wooden shoe" - "coer en sabot" - configuration of the cardiac shadow. Decreased pulmonary arterial vascularity is suggested by the decreased size of the central pulmonary arteries shadows and absence of distal arterial markings. A right aortic arch is suggested by shift of the tracheal air shadow to the left caused by the arch passing to its right and the aortic knob to the right of the mediastinal shadow.

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