A routine chest x ray picked up first clues
clinical correlation and further evaluation by CT scan/echocardiography is suggested.
The CT images nicely show subvalvular stenosis with post stenotic dilatation of the pulmonary trunk. The left PA is dilated,while the right PA is normal in caliber. There is no mosaic perfusion- which is contesting against airway casue or pulmunory artereal hypertension as the cause of the dilatation of the pulmunory artery. The ratio of the segmental PA and adjacent bronchi is <1 , which is also contesting against precapillary pulmonary hypertension.
(Images not shown here) The RV is showing wall thickening (thickness of the free wall of the TV is > 4mm). However, there is no leftward bowing of the IV septum. There is evidence of only very minimal regurgitation of the contrast in to the IVC (images not included). The pulmonary veins are normal in caliber, which is contesting against pulmonary venous hypertension.