Boot shaped heart

The frontal chest x-ray shows boot-shaped heart and pulmonary plethora.

Tetralogy of Fallot can cause above appearance due to right ventricular hypertrophy with resultant elevation of the cardiac apex but with reduced pulmonary markings due to associated pulmonary stenosis.

I do not have follow up on the case. A neonate with abnormal chest x-ray as above should be referred to cardiologist for urgent work up.

Further reading – https://hawaii.edu/medicine/pediatrics/pedtext/s07c03.html