Abstract
Several decades ago a chest X‐ray had a key role in the diagnostic workup of a patient with congenital heart disease. This chapter reviews the classic approach to radiographic interpretation in a neonate with congenital heart disease. It looks at some congenital heart lesions where the radiograph may have diagnostic value. The chapter reviews the secondary role of the radiograph in evaluating lines and tubes, looking for postoperative complications, and assessing fluid status. Classic interpretation was based on evaluating the following: pulmonary vascularity, cardiomegaly, situs, great vessels, and extracardiac structures. A cyanotic patient with decreased pulmonary vascularity would suggest differential diagnoses of tetralogy of Fallot, pulmonic atresia, tricuspid atresia, and Ebstein anomaly. The oft‐quoted “boot‐shaped” heart is classically seen in patients with tetralogy of Fallot but may be seen in other heart lesions where there is right ventricular hypertrophy.