Cyanotic heart defect chest x ray

A chest radiograph is helpful in differentiating between cardiac and pulmonary disorders.

Heart Shape and size –

• Patients with left-sided obstructive lesions may have cardiomegaly due to heart failure.
• Tetralogy of Fallot – Boot-shaped (coeur en sabot) heart.
• D-transposition of the great arteries – Egg-on-a-string pattern caused by a narrow mediastinal shadow produced by the anterior-posterior rather than right-left relationship of the great arteries.
• Total anomalous pulmonary venous connection-A large supracardiac shadow due to anomalous pulmonary vein and persistent left superior vena cava can be seen, which together with normal cardiac shadow forms a snowman appearance.

Pulmonary vascular markings —

• The pattern of pulmonary blood flow depends upon the specific cardiac lesion.
• Decreased pulmonary vascular markings occur in most cyanotic CHD lesions
• Increased pulmonary vascular markings occur in patients with truncus arteriosus or mixing lesions, such as common atrioventricular canal, as pulmonary vascular resistance falls after delivery.

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