The document describes various congenital heart defects categorized into 5 groups based on their appearance on chest x-ray. Group I lesions show increased pulmonary blood flow without cyanosis. Group II lesions cause cyanosis with decreased lung vascularity and normal heart size. Group III lesions also cause cyanosis but with decreased lung vascularity and enlarged heart. Group IV lesions have increased pulmonary blood flow causing cyanosis. Group V shows signs of pulmonary venous congestion. Specific defects are described within each group along with their characteristic chest x-ray findings.

1.  Group I lesions: acyanotic; pulmonary arterial overcirculation
 Group II lesions: cyanotic; decreased pulmonary vascularity, no cardiomegaly
 Group Ill lesions: cyanotic; decreased pulmonary vascularity; cardiomegaly
 Group IV lesions: cyanotic; pulmonary arterial overcirculation
 Group V lesions : pulmonary venous congestion
CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS

2. Group I lesions: acyanotic; pulmonary arterial overcirculation
 ASD
 PAPVC
 AVCD(endocardial cushion defect)
 VSD
 PDA
 Other aortic level shunts (e.g., RSOV, AP window)
CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS

3. Group II lesions: cyanotic; decreased pulmonary vascularity, no
cardiomegaly
 TOF
 Transposition with pulmonic stenosis and VSD
 DORV with PS and VSD
 DOLV with PS and VSD
 Single ventricle with PS
 CCTGA with PS and VSD
 Pulmonic atresia with intact ventricular septum, type I
 Some types of tricuspid atresia (large ASD and pulmonary stenosis
or atresia)CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS

4. Group Ill lesions: cyanotic; decreased pulmonary vascularity;
cardiomegaly
 Ebstein's anomaly
 PA (critical) with ASD or PFO
 Some types of tricuspid atresia (restrictive ASD)
 Pulmonary atresia with intact ventricular septum, type II
 transient TR of the newborn
CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS

5. Group IV lesions: cyanotic; pulmonary arterial overcirculation
 TGA without PS
 Truncus arteriosus
 TAPVC-non obstrcutive
 Tricuspid atresia without PS
 Single ventricle without PS
 DORV without PS
 Double-outlet left ventricle
 Pulmonary AV fistulae
CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS

6. Group V -pulmonary venous congestion
 Critical CoA
 Critical AS
 TAPVC-obstructive
CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS

7. CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS

8. ATRIAL SEPTAL DEFECT
 RAE,RVE
 Dilation of RVOT -smooth continuity with enlarged PT above
OS ASD
 RVE, RAE .
 LV is hypovolaemic and hypoplastic.
 RPA is more prominent than LPA giving radiological sign of jug-
handle appearance.
OP ASD
LV enlargement also
SVC type SINUS VENOSUS ASD
SUBTLE LOCALIZED DILATION OF SVC AS IT JOINS RA
CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS

9. ASD
CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS

10. 1.
Pulmonary vascularity –decreased but peripheral
pruning does not occur
PT and its right branch are dilated and contain
eggshell calcium (Ca).
RA is enlarged, and a dilated RV occupies apex.
Cardiomegaly persist despite devolepment of ES
CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS

11. VSD
 Cardiomegaly : proportional to volume
overload
 LV, LA and RV enlargement
 ascending aorta is inconspicuous.
 Both PAs are equally prominent.
 Rt aortic arch-2%
 Large shunts in infants - hyperinflated
lungs with flat hemidiaphragms
CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS

12.  appreciable enlargement of LV in context of no more than a modest
left-to-right shunt
 ascending aorta is prominent and pulsates vigorously on fluoroscopy.
 perimembranous or subarterial VSD- onset of AR is insidious, so x-ray
initially reflects left-to-right shunt. As time goes on, balance shifts
CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS

13. AVCD
 11 ribs, double manubrial ossification ,tall vertebral bodies
 When left AV valve regurgitation coexists, RA is especially enlarged
because regurgitant flow is directed into RA cavity
 left cardiac border is straightened by a prominent RVOT
 Dilated RA occupies right lower cardiac border,
and LV can occupy apex despite RV enlargement
 Dilated PT may be eclipsed by a prominent RVOT
 ascending aorta is inconspicuous
CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS

14. CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS

15.  lateral x-ray in Down syndrome -
double manubrial ossification center
 PA projection consistently discloses an absent or
rudimentary 12th rib
 Hyperinflation of lungs = upper airway obstruction in
Down syndrome flattens hemodiaphragms
CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS

16.  disproportionate RA enlargement
 cardiac silhouette occasionally has a ball-like shape
 right side of ball -large RA
 left side of ball -dilation of RV infundibulum and LV
CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS

17. LA LV RA AO PT
VSD ↑ ↑ ↔ ↓ ↑
AVCD ↑ ↑ ↑ ↓ ↑
VSD - AR ↔ ↑ ↑ ↔ ↑ ↔ ↑
GERBODE ↑ ↑ ↑ ↓ ↑
CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS

18. PATENT DUCTUS ARTERIOSUS
 Enlargement of left heart chambers.
 Enlargement of ascending aorta or
aortic arch.
 Pulmonary plethora with enlarged
central and peripheral artery.
 Filling up of angle between aortic
arch and PA(radiological AP Window):
Most specific sign.
• Possible PDA calcification in
adults(inverted Y shaped )
 Both PAs are equally dilated
CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS

19. CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS

20. PAPVC
 Pulmonary arterial overcirculation: This may be apparent or more severe only in the lung
with anomalous drainage.
 RAE
 RVE
 Enlargement of main and hilar pulmonary arterial segments
 Small ascending aorta and aortic arch
 Enlargement of SVC, azygous vein, CS or other systemic veins, depending on site of
connection
 Prominent LSVC
 Abnormal course of pulmonary veins through the lung or in relation to mediastinal
margins
CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS

21. SCIMITAR Syndrome
CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS
• scimitar sign
• RPA is hypolplasic-small right hilar shadow
Dextroposition of
heart
Hypoplasia
of right lung

22. CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS

23. TETROLOGY OF FALLOT
 Decreased pulmonary vascularity -Normal vascularity in a cyanotic individual is
equated with decreased vasculariy since the distinction between normal and mildly
decreased vascularity is frequently difficult.
 Normal or nearly normal cardiac size
 shape of a wooden shoe or boot (in French, coeur en sabot) = uplifting of cardiac
apex due to RVH and concavity of MPA
 Concave or absent MPA
 Small hilar pulmonary arteries: This may be most evident on the lateral view.
 Dilated ascending aorta
 right aortic arch = 25% .
 Asymmetric pulmonary vascularity is frequent, especially because of associated
branch PA stenosis.
 Lsvc shadow
 Unilateral rib notching after BT shunt
CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS

24. CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS

25. TOF with pulmonary atresia
 Bilateral reticular formation -bronchopulmonary collaterals-Lacy reticular pattern without the
normal diminution in vessel caliber toward the periphery because systemic arterial collaterals
anastomose with segmental or lobar intrapulmonary arteries
 When systemic arterial collaterals or bronchial collaterals anastomose
with hilar or extrapulmonary arteries, intrapulmonary branching is normal
 patterns of collateral arterial circulation are not uniform, with some areas oligemic and others
normal or hypervascular
 Systemic collateral arteries rarely cause rib notching because they do not run in intercostal
grooves.
 Cardiac size tends to be larger in response to flow through systemic arterial collaterals
reticular lacy
appearance

26. CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS

27. TOF with absent pulmonary valve
 Decreased distal pulmonary vascularity
 Cardiac size variable, depending on severity of PR
 Infundibular dilation projects leftward as a hump-
shaped shadow
 dilated RV occupies the apex
 enlarged RA
 Pulmonary vascularity is normal rather than
decreased.
CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS
Aneurysmal enlargement of
main and central
pulmonary arteries

28. CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS

29. EBSTEINS ANOMALY
cardiac silhouette
• near normal to diagnostic
• Heart size in symptomatic infants is immense
Pulmonary vascularity
• normal in mild acyanotic Ebstein’s
• reduced when anomaly is severe and cyanotic .
infundibulum
• straightens left cardiac border or forms a conspicuous convex shoulder
RA silhouette
• almost always enlarged .
• seldom normal even when cardiac silhouette is normal
CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS

30. EBSTEINS ANOMALY
BOX SHAPED HEART
• Marked rightward convexity of enlarged RA + marked
leftward convexity of enlarged infundibulum .
vascular pedicle
• narrow because PT is not border forming and ascending
aortic shadow is inconspicuous or absent .
• resembles pericardial effusion
CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS

31. EBSTEINS ANOMALY
CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS
Result of marked angulation at superior vena caval-
RA junction as RA enlarges.

32. PA WITH INTACT IVS
TYPE 1
 cardiac silhouette at birth may be normal .
 PA segment is normal because PT develops normally despite PV atresia
 ascending aorta is enlarged
 RA shadow is moderately prominent
 well formed convex LV occupies apex
TYPE 2
 cardiac silhouette virtually fills chest—“wall-to wall”—remarkable
enlargement of RA and RV
CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS

33. CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS
MPA is normal
ascending aorta (Ao) is enlarged

34. CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS

35. TA
restrictive VSD and NRGA(type 1b)
• right cardiac contour – distinctive ,enlargement of RA and its appendage and accentuated by a
flat receding inferior border that reflects absence of RV
• Hump like on right cardiac border
• convex LV occupies apex
• Pulmonary vascularity is reduced
• MPA is inconspicuous
• ascending aorta -prominent
• Normal vascular pedicle
• Rt aortic arch-5-8%
intact ventricular septum(type 1a)
• ascending aorta is more conspicuous
• lung fields -lacy vascular pattern of systemic arterial collateralsCHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS

36. CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS
large LV occupies the apex
Pulmonary vascularity is
reduced
ascending aorta (Ao) is
prominent
MPA is
inconspicuous
dilated RA recedes acutely
because of absence of RV

37. VSD is nonrestrictive and PVR is low(1c)
• pulmonary vascularity is increased
• PT and LA and RA are enlarged
• prominent LV is apex-forming
tricuspid atresia with complete TGA, a nonrestrictive VSD , and low PVR(II c)
• increased pulmonary vascularity
• Inconspicuous Aorta
• enlargement of LA and RA( CARDIOMEGALY)
• prominent apex-forming LV.
• vascular pedicle is narrow
• resembles uncomplicated complete TGA
• Left cardiac border is straight if there is left-sided juxtaposition of atrial appendages.
PVR is increased
• lungs are oligemic
• heart size is normal or nearly soCHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS

38. TA + TGA + PS(type 2b)
 normal or reduced pulmonary vascularity
 prominent RA
 Convex LV
 narrow vascular pedicle
juxtaposition of the atrial appendages
 pointed bulge on the left border of the mediastinal shadow
below the region where PA should be seen
 right border of RA is straight because the absence of RV pulls
the border toward RA.

39. CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS
JUXTRA POSITION

40. Pulmonary
oligaemia
Normal
vascular pedicle
1B
Narrow
vascular pedicle
II B
Pulmonary
plethora
Normal
vascular pedicle
IC
Narrow
vascular pedicle
IIC
Lacy reticular
pattern
1A
CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS

41. CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS

42. TRANSPOSITION OF GREAT ARTERIES
 RA border is abnormally convex
 LA is enlarged because of increased PBF.
 egg on its side.
 Increased CT ratio with egg lying on its side
appearance
 blunter right border of egg =RA
 convex left border –LV
CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS

43. D-TGA ,VSD without PS
 neonatal x-ray -Normal
 typical features –once PVR falls and PBF increases
 Increased pulmonary vascularity
 distribution of PBF favors right lung because of rightward
direction of PT
 A progressive increase in flow into right lung may culminate in
a substantial decrease in flow to left
 crural portions of hemidiaphragms are low when
lungs are hyperinflated
CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS
D
T
G
A

44.  Thymic shadow is almost always absent after first 12
hours of life
 narrow vascular pedicle -PT is posterior and medial
 pedicle is narrowest when ascending aorta courses
vertically upward directly anterior to PT
 aortic root is seldom sufficiently rightward to be border
forming except when ascending aorta enlarges in
presence of leftward and posterior malalignment of
infundibular septum
CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS
D
T
G
A

45.  vascular pedicle - widens when a dilated hypertensive posterior
PT is convex to left
 When PS and VSD coexist- right aortic arch is
present in 11% to 16%
 lateral projection= heart assumes a circular appearance
because an enlarged RV merges with anterior aorta, and an
enlarged LV merges with dilated posterior LA; widened
vascular pedicle
 Discrepency between pulm plethora & hilar and main pulm
arteries due to midline position of PT
CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS
D
T
G
A

46. Juxtaposition of atrial appendages
localized bulge along mid left cardiac border that represents
contiguous mass of two appendages
↑ PVR
 lung vascularity decreases, size of LV and LA decrease, and a dilated
hypertensive posterior PT emerges at left base
Severe fixed PS
decreased pulmonary vascularity, a small LV, a small LA, and enlargement
of RV and RA
CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS
D
T
G
A

47. D TGA
CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS
Narrow vasc
pedicle
RA border is
abnormally convex
Increased
pulmonary
vascularity
egg on its side.
Thymic shadow is absent

48.  All four chambers are dilated with pulmonary
plethora.
 Left side chamber enlargement > right side
chamber enlargement
 Enlargement of RV and RA –CCF /incompetent
biventricular truncal valve.
 1/3 rd of cases right aortic arch .
 large truncus arteriosus resembles a large
ascending aorta that may continue as a right
aortic arch (35%) and a high transverse aortaCHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS

49.  ↑ pulmonary vascularity
 MPA segment is prominent (type 1)
 MPA segment is absent (type 2 or 3)-concave profile -RAO
 prominent LPA may reveal itself as a high shadow that curves upward to form a
left hilar ( especially evident in right aortic arch)-HILAR COMMA SIGN
 convex MPA segment of truncus type 1 tends to arise at a higher level compared
with other forms of PA dilation
 arterial pedicle appear narrow
 discrepancy between the vascular markings on the two sides -unilateral atresia,
or absence, of one PA
 Absence of PA is usually on same side as aortic arch in contrast to TOF
CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS
t
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50. older adults with PAH
 Dilated hypertensive MPA segment is especially
prominent
 ↓ pulmonary vascularity
 increased prominence of MPA and its right and left
branches
 relatively normal LV
CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS
t
r
u
n
c
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s
a
r
t
e
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i
o
s
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s

51. CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS
 snowman or figure of eight appearance.
 Supracardiac type to LIV,mixed variety(<1/3rd cases)
 head of snowman
 dilated vertical vein on left
 innominate vein on top
 SVC on right
 body
 enlarged RA

52. Without
PVO
↑ PBF
RA,RV,PA-
enlarged
With PVO
Pulm venous
HTN signs
No
cardiomegaly
Reticular
pattern
Kerly b lines
Ground glass
opacities
CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS

53. snowman or figure of eight appearance
 Develops once PVR falls(3-6 months)
 VSD associated with large THYMUS- Psudo snowman appearance
 Anamalous drainage to RSVC-bulge on right upper mediastinus
 Aortic knob-small.
CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS

54. TAPVR
CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS

55. CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS

56. DOUBLE OUTLET RV
 Generalized cardiomegaly
 increased pulmonary vascularity.
 aorta and PA have a more side-to-side
configuration-cardiac waist is
relatively wider
CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS

57. DORV WITH SUB AORTIC VSD(no PS)
CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS
 low PVR
 ~ non-restrictive perimembranous VSD with ↑ PBF
 Thymus is present even though there is transposition of
aorta
 PT is prominent because it carries increased volume at systemic pressure and is not
posterior to aorta
 LA and LV enlargement
 CCF= RA and RV dilate
 elevated PVR (before neonatal fall or after development of PVD)
 lung fields are oligemic
 RV copes with systemic resistance without enlarging significantly
 ~non-restrictive VSD and ES

58. CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS
pulmonary vascularity is increased
prominent RA
dilated LV occupies the apex
PT is moderately convex

59. DORV WITH SUBAORTIC
VSD AND PS (resembles TOF)
 PT is not dilated
 When PS is mild, pulmonary vascularity is increased and LV is
dilated
 When PS is severe, pulmonary vascularity is
reduced, heart size is normal, and apex is convex
 pulmonary atresia= ascending aorta is enlarged, MPA is
concave, and apex is boot-shaped.
CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS

60. DORV WITH SUBPULMONARY
VSD: TAUSSIG-BING ANOMALY
 increase in pulmonary arterial and pulmonary venous vascularity results
from low PVR and CCF
 LA and LV are enlarged
 RA and RV are enlarged - CCF
 dilated PT projects prominently to left when great arteries are side-by-
side-resembles a nonrestrictive perimembranous VSD
 When dilated PT is posterior and therefore not border-forming, x-ray
resembles D TGA except for presence of a thymus
CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS

61. CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS
Pulmonary vascularity is increased
thymus
enlarged RA

62. ↑ PVR
 PBF decreases
 pulmonary venous vascularity disappears
 Volume overload of LV is curtailed, but dilation
of PT persists
 resembles a nonrestrictive VSD with ES
CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS

63. SV
inverted outlet chamber
 localized convexity at upper left cardiac border
 aorta -convex to left or rises vertically as
in CCTGA
 A transposed posteromedial PT may lift its dilated right branch and create a waterfall
appearance
Holmes heart
 inverted outlet chamber is distinctively convex
 concordant PT
noninverted outlet chamber
 aorta -convex to right but is not border-forming as is case in D-TGA
 Narrow vasc pedicle
 Thymus present
CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITION
S

64. single morphologic left ventriclewith
inverted outlet chamber
CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS
OC forms a convex bulge
and gives rise to the aorta
Ao
SV and RA
are dilated

65. single morphologic left ventricle and a
noninverted outlet chamber
CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS
Dilated right
atrium (RA)
narrow
vascular
pedicle

66. SV
 With exception of Holmes heart great arteries are
transposed ( aorta from OC and PT from m LV)
 size of cardiac silhouette increases -excessive PBF and volume
overload of SV
 LAE-lateral films or with a barium esophagram because what
appears to be LA appendage in PA projection is an inverted OC
 RA dilation- CCF, which is reinforced by subaortic stenosis
CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS

67. SV
single Mlv with severe PS inverted outlet chamber
 size of heart is normal
 inverted outlet chamber -bulge at left upper cardiac border
 dilated aorta that arises from an inverted outlet chamber -
convexity to left or that ascends vertically and is not border-
forming on either side
Pulmonary atresia with an inverted outlet chamber
 box-like cardiac silhouette
 dilated ascending aorta forming left upper border that merges
with a small underfilled ventricle below and vertebral column
forming straight right border
CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS

68. single morphologic lv and severe PS
noninverted outlet chamber
CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS No cardiomegaly.

69. Holms Heart
CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS

70. SV-univentricular hearts of RV morphology
 both GAs necessarily arise from single RV
 a form of DORV
 vascular pedicle is narrow -aorta is anterior and PT is
posterior or wide if side-by-side.
 PS is common
 pulmonary vascularity is normal or reduced
 heart size is not significantly increased.
CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS

71. CCTGA
 normal - distinctive triad of contours that consists of ascending aorta on
right and aortic knuckle and PT on left
 CCTGA- this triad is lost because aorta does not ascend on right and PT is
not border forming on left
 MC relationship
ascending aorta -anterior and to left
medially and posteriorly positioned PT
 ascending aorta at left base varies from absent to straight to gently
concave to moderately convex to strikingly convex
CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS
C
C
T
G
A

72. CCTGA
 Less commonly , ascending aorta rises vertically and anterior to
posterior PT, so neither great artery is border forming
 posterior and rightward PT tilts right branch upward and left branch
downward, so that two branches are at same level
 dilated posterior PT can displace SVC to right, forming a right basal
shadow or may project as a right basal convexity that can be mistaken for
ascending aorta
CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS
C
C
T
G
A

73. CCTGA
 silhouette of mRV : (1) a hump-shaped appearance
(prominent inverted infundibulum ) (2) a septal notch(subtle
indentation just above left hemidiaphragm corresponding to
apical position of interventricular groove )
 hump-shaped infundibular shadow occupies site of left
atrial appendage so LAE is best identified in a lateral
projection.
 giant LA- huge ball suspended below a narrow vascular
pedicle ( due to left AV valve regurgitation or Ebstein anamoly
or ↑ PBF )
CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS
C
C
T
G
A

74. L TGA
 RPA high take-off because of an absent aortic
shadow and is also quite prominent
waterfall" appearance - prominence of Rt
pulmonary hilum with displacement
medially and superiorly.
left heart border boxlike, straightened
 Dextrocardia usually occurs with normal
abdominal situs (20 percent of ccTGA )
 abdominal situs solitus and dextrocardia
should raise suspicion of ccTGA.
CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS
C
C
T
G
A

75. CCTGA , a nonrestrictive VSD, and increased PBF
septal notch
dilated posterior PT
causes rightward
displacement of SVC

76.  Normal pulmonary vascularity
 Normal cardiac size
 RVE: This is usually detected initially on the lateral view as a prominent convexity of the anterior
cardiac border or filling of the retrosternal space.
 Poststenotic dilatation of MPA
 Dilated and usually laterally displaced LPA
CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS

77. CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS
OLIGEMIA
CARDIOMEGALY
RAE,RVE
DILATED MPA
CRITICAL PS

78. CONG AS
 neonates with severe AS = pulmonary venous
congestion /Pulmonary edema
 Cardiomegaly
 LVE
CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS

79. AS
LEVEL of stenosis
• Calcification (stenosis is valvular)
• Size of aorta
SEVERITY
• dense calcium
• increase in LA size
LV
• remain normal-sized through a wide range of severity
• adaptive response is concentric hypertrophy with a normal or reduced cavity
• enlarges downward and to left and posterior
• frontal view -apex extends below left hemidiaphragm
• Left lateral projection-extends behind IVC
CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS

80. CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS
Valvular AS
Subvalvular AS

81. Significant LV
enlargement
infants - severe AS
and CCF
adults = CCF, whether
or not AS is severe
CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS

82. ascending aorta
Dilation
bicuspid AS
Turner’s syndrome
normal
fixed subvalvular
aortic stenosis
50%-dilated Aorta
normal to small
supravalvular AS
undersized
hypoplasia of
ascending
aorta
hypoplastic aortic
annulus and a
miniature valve
CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS

83. CoA
infants
asymptomatic
x-ray is normal
symptomatic infants
pulmonary venous congestion
with dilation of RV and RA and
LA
LV size remains normal
children and young adults
postcoarctation descending
thoracic aorta has a distinctive
leftward convexity + dilation of
LSCA
Rib notching
CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS

84. CRITICAL COA
 pulmonary venous hypertension / pulmonary edema
 Cardiomegaly
 LV enlargement
 No rib notching/aortic knob is not characterstic
 Pulmonary plethora-VSD/PDA
CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS

85. Notching of ribs
 collateral flow through dilated, tortuous, pulsatile posterior
intercostal arteries
 Notches vary from rib to rib and from patient
to patient and may be single, multiple, shallow, deep,
broad, or narrow.
 anterior ribs are spared because anterior intercostal arteries do
not run in intercostal grooves.
 Rib notching seldom appears before age
6 years
 Lateral x-rays = retrosternal notching or scalloping caused by
dilated tortuous IMA
CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS

86. • bilateral notching between third & eighth ribsCoA distal to LSCA
• unilateral rib notching of right hemithorax
LSCA lumen is
compromised
• unilateral notching of left hemithorax.
Anomalous origin of RSCA
distal to coarctation
• confined to lower ribsabdominal CoA
CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS

87.  older children and adults = ascending aorta is moderately to markedly
dilated
 Turner’s syndrome-ascending aorta may be aneurysmal
 Proximal and distal paracoarctation aorta -dilated
 calcification is occasionally visible in wall of aneurysm.
 dilated LSCA proximal to coarctation and a dilated aorta distal to
coarctation -figure 3 silhouette
 mirror image of figure three sign - barium esophagram
 LSCA cannot dilate when its lumen is compromised
by coarctation, so dilation of distal paracoarctation aorta exists alone
CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS

88. CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS
figure 3 silhouette
CoA that obstructed the orifice of
LSCA which is therefore not dilated
unilateral notching
of the ribs
ascending
aorta (AAo) is
dilated

89. Coarctation of aorta
LAO , obtained with barium esophagography
CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS

90. irregular scalloped notching of inferior margins of
posterior ribs
CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS

91. CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS
Aortic obstruction
• COA
• IAA
• Acquired obstruction of the aorta: Takayasu's aortitis, atherosclerotic obstruction,
• Unusual causes of coarctation: neurofibromatosis, Williams' syndrome, rubella syndrome
Subclavian arterial obstruction
• BT shunt (upper 2 ribs)
• Takayasu's arteritis (usually unilateral)
• Atherosclerosis
Severely reduced pulmonary blood flow
• TOF
• Pulmonary atresia
• Tricuspid atresia
• Unilateral absence or atresia of a PA
• Pulmonary emphysema
• Chronic pulmonary thromboernbolic disease
• Superior vena canal obstruction
Vascular shunts
• Pulmonary AV shunt
• Intercostal AV shunt
• Intercostal to PA shunt
• Intercostal neuroma Poliomyelitis (upper margin)
• Hyperparathyroiclism

92.  retroesophageal aberrant RSCA -posterior indentation of
barium esophagram
kinked aorta of pseudocoarctation
 transverse arch and a descending aorta that form a large 3 sign
above and below kink
 rib notching is conspicuous by its absence .
CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIONS

93. IAA
 cardiac silhouette enlarges and pulmonary venous
congestion develops rapidly when closure of DA suddenly causes an
increase in PBF and volume overload of LV.
 aortic knuckle is absent (ascending aorta
is small and ascends vertically)
 trachea is not deviated by an aortic arch and is therefore midline.
 Severely increased pulmonary venous and pulmonary arterial
vascularity with enlargement of LV- VSD or PDA
 Isolated IAA without PDA or VSD is radiologically similar to CoA ,
including rib notching
CHEST X RAY IN DIAGNOSIS OF CARDIAC CONDITIO
NS