No radiographic evidence of acute cardiopulmonary disease
Enlargement of the right ventricle with boot-shaped configuration of the heart
Median sternotomy wires with a surgical clip overlying the superior mediastinum
Tetralogy of Fallot
No radiographic evidence of acute cardiopulmonary disease.
Enlargement of the right ventricle with boot-shaped configuration of the heart, which is typical for Tetralogy of Fallot.
This patient has already undergone partial repair (hence the median sternotomy wires) so the diagnosis of Tetralogy of Fallot is no mystery to the referring clinician in this case
Although the defect is a tetralogy, it results from one problem: abnormal anterior position of the conal septum which narrows the right ventricular outflow tract, causes the aorta to override the septum, and results in a ventricular septal defect
Right ventricular hypertrophy results in uplifting of the left ventricular apex and a boot-shaped configuration of the heart
Although the aortic arch is on the left in this case, patients with Tetralogy of Fallot have a right arch in about 25% of cases
As with other right-sided heart defects (like Ebstein anomaly and tricuspid atresia), Tetralogy results in decreased pulmonary blood flow
Refer to the annotated image below for an algorithmic approach to congenital heart disease on radiographs
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