Ventricular septal defect
Term baby. Increased work of breathing when feeding.
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The heart is enlarged and the lungs are plethoric. The features are not specific of the diagnosis, but warrants a cardiac workup including an echo.
This 3 month old has a VSD with a left to right shunt - patients classically present with increased work of breathing when they feed and associated cyanosis.
The heart is enlarged (cardiomegaly) and there is pulmonary vascular prominence in the outer third of the lungs (pulmonary plethora). In addition, the ventricular apex is elevated which suggests right ventricular enlargement.