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Age: 17

Sex: Female

Indication: Chest pain

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Case #10


Findings

  • 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


Diagnosis

  • Tetralogy of Fallot

Sample Report

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.


Discussion

  • 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


Images

Algorithmic approach to congenital heart disease on radiographs.

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