X-Ray chest PA View of a chid with ventricular septal defect and left to right shunt and hyperdynamic pulmonary hypertension. There is cardiomegaly, prominent main pulmonary artery segment and right pulmonary artery. Enlarged left pulmonary artery shadow is seen below the lef cardiac border, within the cardiac silhouette. The enhanced vascular markings are visible on the right side whereas it is obscured by the cardiac shadow on the left side. This child needs cardiac cathterisation for evaluation of shunt and pulmonary vascular resistance and its reversibility to decide on surgical option.