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©2013 UpToDate ® Print Email Chest x-ray in a patient with Eisenmenger syndrome This chest x-ray of a patient with Eisenmenger syndrome secondary to an atrial septal defect demonstrates cardiomegaly due to right heart enlargement, prominence of the central pulmonary arteries, and peripheral "pruning" of the pulmonary vasculature (abrupt attenuation and/or termination of peripheral pulmonary artery branches). Courtesy of Heidi Connolly, MD. Normal chest radiograph Posteroanterior view of a normal chest radiograph. Courtesy of Carol M Black, MD.