A 'boot-shaped' heart : is the description given to the appearance of the heart on plain film in some cases of Tetralogy of Fallot. It describes the appearances of an upturned cardiac apex due to right ventricular hypertrophy and a concave pulmonary arterial segment., the toe of the boot is formed by the upward pointing cardiac apex which make an acute angel with the diaphragm . The narrow upper part of the boot results from small or absent main pulmonary artery . Note the hyperlucent lungs ,diminshed central hilar pulmonary vessels and an upturned cardiac apex ,main pulmonary artery segment is flat to concave.
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