This patient had undergone corrective surgery for tetralogy of Fallot (TOF) many years previously
The X-ray can be considered ‘normal’ for this patient even though the pulmonary arteries are enlarged and there is also a right-sided aorta – a common associated anatomical variant in patients with TOF
The appearances of a chest X-ray can be confusing following surgery for correction of congenital anomalies – reference to the surgical history is required