Roentgenology of tetralogy of Fallot

Abstract

If the patient is cyanotic and has EKG evidence of right ventricular hypertrophy, tetralogy can be suggested from the plain chest film. The characteristic plain film findings are a slightly enlarged heart with an elevated apex, a prominent aorta, an inconspicuous pulmonary artery and decreased pulmonary vascularity. Helpful associated findings are a right aortic arch and disproportionate decrease in left pulmonary vascularity. If the heart is large, an additional anomaly, especially atrial defect, should be suspected. Angiography is often needed to distinguish tetralogy from pseudotruncus, truncus, transposition, single ventricle and double outlet right ventricle. Angiography is vital for alerting the surgeon to the anatomy of the obstruction. Obstruction to right ventricular outflow may be demonstrated at any one or combination of five levels: the infundibulum, pulmonary valve, valve ring, main pulmonary artery or left pulmonary artery.