X-Ray chest PA View of a child 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 left 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 catheterisation for evaluation of shunt and pulmonary vascular resistance and its reversibility to decide on surgical option.