The frontal chest x-ray shows hugely dilated pulmonary trunk and descending pulmonary arteries. There is pruning of peripheral pulmonary vessels. This patient was diagnosed with idiopathic pulmonary hypertension on subsequent investigations.

Idiopathic pulmonary hypertension involves women more than men. Dyspnea, weakness, syncope are among common presenting symptoms with cough, fatigue, anorexia, chest pain being less common symptoms. The disease typically involves younger women but can present in 4th or 5th decade.

Chest x-ray findings are usually delayed. Features include dilated central pulmonary arteries with peripheral pruning, oligaemia of lung fields, right ventricular enlargement with obliterated retrosternal space on lateral view, right atrial enlargement with bulging right heart border on frontal chest x-ray.

Reference: https://emedicine.medscape.com/article/301450-overview