The authors evaluated the normal radiographic anatomy of the innominate (brachiocephalic) artery in children. Review of 1,000 randomly selected lateral chest radiographs demonstrated anterior tracheal indentation in 30% of the children under the age of 2 years. In addition, 172 angiograms in children with congenital heart disease revealed that the innominate artery normally originates either completely or partially to the left of the trachea and crosses in front of it.