This patient present with cardiomegaly and large bilateral pulmonary arteries on chest radiograph. It was further investigated for pulmonary embolism, in which CTPA was performed. CTPA shows poor contrast opacification of pulmonary vessels (likely due to mixture of contrasted and non-contrasted blood). There is also suspicious communication at aorta and pulmonary arteries. CTA thoracic aorta was performed which confirm the presence of patent ductus arteriosus. The contrast from the aorta clearly flow into the pulmonary artery system, in which opacifies the pulmonary arteries.

The arterial circulation is still higher pressure compared to pulmonary arterial circulation in this case. Eisenmenger phenomenon still did not occur in this patient (which pulmonary artery circulation is higher pressure compared to arterial circulation).

This patient likely have Krichenko classification type B (window, short and wide ductus with blending of pulmonary artery).