Classic Chest X Ray findings in Congenital heart disease

Last modified: Monday, August 21, 2017
Here I have tried to compile a list of congenital heart disease with typical chest x-ray finding.

First of all Normal X-ray with heart silhouette


1. Tetralogy of Fallot :Boot Shaped heart 
"Coeur en sabot"
Upturned cardiac apex due to right ventricular hypertrophy and concave pulmonary arterial segment. All features may not be present though. Pulmonary oligaemia due to decreased pulmonary arterial flow. Right sided aortic arch is seen in 25%.

2. Total anomalous pulmonary venous return ( TAPVC)  : Snowman sign or figure of 8
The paratracheal shadow on the right is the prominent SVC and on the left is the vertical vein. The innominate vessel lies in the midline above base of heart. These three prominent vessels together form the head of the 'snowman'. The body is formed by the rest of the heart..

3. TGA ( Transposition of great Arteries) : Egg on a string
There is often an apparent narrowing of the superior mediastinum as the result of the aortic and pulmonary arterial configuration.

4. Coartation of Aorta: 3 sign on Radiograph and "E" sign on Barium enema
The characteristic bulging of the sign is caused by dilatation of the aorta due to an indrawing of the aortic wall at the site of cervical rib obstruction, with consequent post-stenotic dilation. This physiology results in the '3' image for which the sign is named.

5. Ebstein Anomaly: Globular heart

There is often severe right-sided cardiomegaly due to an elongated and enlarged right atrium which may result in an elevated apex. Classically, the heart is described as having a "box shape" on a frontal chest radiograph.

6. Partial Anomalous Pulmonary Venous Return: Scimitar Sign:

7. Endocardial Cushion Defect: Goose-neck Sign





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