PLAIN RADIOGRAPHIC DIAGNOSIS OF CONGENITAL HEART DISEASE

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Colin McMahon, M.B.BCh.
Edward Singleton, M.D.

Texas Children's Hospital, Houston, Texas
Texas Heart Institute
Edward B. Singleton Diagnostic Imaging Service


Hypertext fomatting: Joseph Magee, Ph.D.
1. The normal chest radiograph

Image and description.
2. Conditions with increased pulmonary vascularity.
  1. Atrial septal defect, secundum.
    1. Posteroanterior (PA) chest radiograph.

      Condition Description: Atrial Septal Defect (ASD)

  2. Ventricular septal defect.
    1. Moderate left to right shunt
      1. PA chest radiograph.
      2. Right anterior oblique view.
    2. Large left to right shunt.
      1. PA chest radiograph.
    3. Large left to right shunt.
      1. PA chest radiograph.
      2. Right anterior oblique film and barium swallow.

      Condition Description: Ventricular Septal Defect (VSD)

  3. Atrioventricular septal defect.
    1. Atrioventricular septal defect (Down syndrome).
      1. PA radiograph.
    2. Atrioventricular septal defect (Down syndrome).
      1. PA radiograph.

      Condition Description: Atrioventricular septal defect (AVSD)

  4. Patent ductus arteriosus.
    1. Patent ductus arteriosus.
      1. PA radiograph.
      2. Right anterior oblique view.

      Condition Description: Patent Ductus Arteriosus (PDA)

  5. Total anomalous pulmonary venous connection.
    1. Total anomalous pulmonary venous connection (Supracardiac)
      1. PA radiograph.
    2. TAPVC (Supracardiac).
      1. PA chest radiograph.
    3. Total anomalous pulmonary venous connection (infradiaphragmatic-obstructed).
      1. PA chest radiograph.
    4. TAPVC (infradiaphragmatic-obstructed).
      1. PA chest radiograph.

      Condition Description: Total anomalous pulmonary venous connection (TAPVC)

  6. Scimitar syndrome.
    1. Anomalous pulmonary venous connection (Scimitar sign).
      1. (Image and description).
      2. Left anterior oblique view.

      Condition Description: Scimitar syndrome

  7. Transposition of the Great Arteries.
    1. Transposition of the Great Arteries (D-TGA).
      1. (Image and description).
      2. Right posterior oblique view.

      Condition Description: Transposition of the Great Arteries (D-TGA)

  8. Truncus arteriosus.
    1. Truncus arteriosus.
      1. PA chest radiograph in the first week of life.
      2. PA chest radiograph of an older patient.

    9. Condition Description: Truncus arteriosus

  9. Corrected Transposition/ Ventricular inversion, L-TGA.
    1. Corrected Transposition/ Ventricular inversion, L-TGA
      1. PA chest radiograph
      2. (Image).
      3. (Image).

    10. Condition Description: Corrected transposition/ventricular inversion, L-TGA
3. Conditions with decreased pulmonary vascularity.
  1. Tetralogy of Fallot.
    1. Tetralogy of Fallot
      1. PA chest radiograph
      2. Right anterior oblique views
    2. Tetralogy of Fallot, right aortic arch.
      1. PA chest radiograph of a nine month old infant

      Condition Description: Tetralogy of Fallot

  2. Tetralogy/ absent pulmonary valve syndrome.
    1. Tetralogy of Fallot/ Absent pulmonary valve syndrome.
      1. (Image and description)

      Condition Description: Tetralogy of Fallot

  3. Pulmonary atresia/ ventricular septal defect (pseudotruncus).
    1. Pulmonary atresia with ventricular septal defect (Pseudotruncus).
      1. (Image and description)

  4. Tricuspid atresia.
    1. Tricuspid atresia.
      1. (Image and description)

      Condition Description: Tricuspid atresia

  5. Ebstein’s anomaly.
    1. Ebstein’s anomaly.
      1. (Image and descripion)

      Condition Description: Ebstein's Anomaly

  6. Transposition of the Great Arteries with pulmonary stenosis.
    1. Transposition of the Great Arteries with Pulmonary stenosis.
      1. (Image and description).

  7. Pulmonary hypertension/ Eisenmenger’s syndrome.
    1. Ventricular septal defect with pulmonary hypertension (Eisenmenger complex).
      1. PA radiograph
      2. Right anterior oblique view.
      3. (Image and Description).

      Condition Description: Pulmonary hypertension/ Eisenmenger’s syndrome.

4. Conditions with normal pulmonary vascularity.
  1. Aortic stenosis.
    1. Aortic stenosis.
      1. (Image and description)
      2. Right anterior oblique view

      Condition Description: Aortic valvular stenosis.

    2. Aortic supravalvular stenosis.
      1. (Image and description)
      2. Angiocardiography PA view
      3. Angiocardiography lateral view

      Condition Description: Supravalvular aortic stenosis

  2. Coarctation of the Aorta.
    1. Coarctation of the Aorta.
      1. Chest radiograph
    2. Coarctation of the Aorta (severe).
      1. PA chest radiograph
      2. Left anterior oblique film
    3. Coarctation of the Aorta.
      1. PA chest radiograph

      Condition Description: Coarctation of the Aorta.

  3. Interrupted Aortic Arch.
    1. Interrupted Aortic Arch.
      1. Chest radiograph.

      Condition Description: Interrupted Aortic Arch.

  4. Endocardial fibroelastosis (Cardiomyopathy).
    1. Endocardial fibroelastosis (Cardiomyopathy).
      1. PA view
      2. Right anterior oblique view

      Image Review: Endocardial fibroelastosis (Cardiomyopathy).

  5. Pulmonary stenosis.
    1. Pulmonary valvular stenosis
      1. PA chest film
      2. Right posterior oblique view

      Condition Description: Pulmonary valvular stenosis

  6. Mitral stenosis.
    1. Mitral valve stenosis.
      1. PA chest radiograph
      2. Right anterior oblique view

      Condition Description: Mitral valve stenosis

  7. Cor triatriatum.
    1. Cor triatriatum.
      1. (Image and Description)
      2. Angiocardiogram

      Condition Description: Cor triatriatum

  8. Hypoplastic left heart syndrome.
    1. Hypoplastic left heart syndrome
      1. (Image and Description)
    2. Hypoplastic left heart syndrome.
      1. (Image and Description)
      2. (Image and Description)

      Condition Description: Hypoplastic left heart syndrome

  9. Idiopathic pulmonary artery dilation.
    1. Idiopathic pulmonary artery dilation.
      1. (Image and Description)
      2. (Image).

      Condition Description: Idiopathic pulmonary artery dilation
5. Aortic arch anomalies/ Vascular rings.
  1. Double aortic arch.
    1. Double aortic arch.
      1. - B. Cineangiograms

      Condition Description: Double aortic arch

  2. Right aortic arch with left ductus remnant.
    1. Right aortic arch with left ductus arteriosus remnant.
      1. PA chest film
      2. Right lateral view

      Image Review: Right aortic arch with left ductus arteriosus remnant.

  3. Right aortic arch with abberant left subclavian artery.
    1. Right aortic arch with anomalous left subclavian artery and left ductus.
      1. PA chest radiograph
      2. Left Posterior oblique film

      Condition Description: Right aortic arch with anomalous left subclavian artery and left ductus.
6. Malposition cardiac lesions.
  1. Dextrocardia.
    1. Dextrocardia.

      Condition Description: Dextrocardia.

  2. Situs inversus totalis.
    1. Situs inversus totalis.

      Condition Description: Situs inversus totalis.
7. Miscellaneous cardiac lesions.
  1. Congestive cardiac failure (non-cardiac aetiology).
    1. Congestive cardiac failure secondary to glomerulonephritis.
      1. PA chest film
      2. Lateral chest film
    2. Congestive cardiac failure secondary to sickle cell anemia.
      1. PA chest film
      2. Lateral chest film
      3. PA abdominal film

      Condition Description: Congestive cardiac failure (non-cardiac aetiology)

  2. Absent/Hypoplastic pulmonary artery.
    1. Hypoplastic pulmonary artery with hypoplastic lung.
      1. PA chest film

  3. Aneurysm of the pulmonary artery.
    1. Aneurysm of the right pulmonary artery.
      1. PA chest radiograph
      2. Lateral chest radiograph
    2. Aneurysm of the main pulmonary artery.
      1. PA chest radiograph

      Image Review: Aneurysm of the pulmonary artery.

  4. Partial/ complete absence of pericardium.
    1. Partial absence of the Pericardium.
      1. PA chest radiograph
      2. Noncontrast CT Thorax
    2. Congenital absence of Pericardium.
      1. PA chest radiograph

      Condition Description: Partial/ complete absence of pericardium.

  5. Pulmonary arteriovenous malformation.
    1. Pulmonary arteriovenous malformation.
      1. (Image and Description)
      2. Lateral chest film

      Condition Description: Pulmonary arteriovenous malformation.

  6. Congenital ventricular diverticulum.
    1. Congenital left ventricular diverticulum.
      1. PA chest radiograph
      2. -  E. Systolic and diastolic PA and lateral cineangiograms

      Condition Description: Congenital ventricular diverticulum.

  7. Conjoined twins.
    1. Conjoined twins.
      1. Plain film
    2. Conjoined twins.
      1. PA chest radiograph

      Condition Description: Conjoined twins.

  8. Pulmonary varix/varices.
    1. Pulmonary varix/varices.
      1. (Image and Description)
      2. Lateral chest film
    2. Pulmonary varix.
      1. PA chest radiograph
      2. Lateral radiograph

      Image Review: Pulmonary varix/varices.
8. Post-operative conditions.
  1. Atelectasis.
    1. Atelectasis.
      1. (Image and Description).

  2. Pericardial effusion.
    1. Pericardial effusion.
      1. PA chest radiograph

  3. Pleural effusion.
    1. Pleural effusion.
      1. PA chest radiograph.

  4. Pneumothorax.
    1. Pneumothorax.
      1. PA chest film
      2. (Image and Description)

      Image Review: Pneumothorax.

  5. Pneumopericardium.
    1. Pneumopericardium.
      1. PA chest radiograph

  6. Phrenic nerve palsy.
    1. Phrenic nerve palsy.
      1. PA chest radiograph.
  7. Pacemaker.
    1. Pacemaker.
      1. (Image and Description)
    2. Pacemaker.
      1. (Image and Description)

      Condition Description: Pacemaker.

  8. Thoracotomy.
    1. Thoracotomy.
      1. PA chest film

  9. Scoliosis (secondary to thoracotomy).
    1. Scoliosis
      1. PA chest radiograph

  10. Aortic valve replacement.
    1. Aortic valve replacement.
      1. PA chest radiograph.

  11. Mitral valve replacement.
    1. Mitral valve replacement.
      1. PA chest radiograph.

  12. Calcified homograft.
    1. Calcified homograft.
      1. PA chest film
      2. Lateral chest film

      Image Review: Calcified homograft.

  13. A.I.C.D.
    1. Artificial implantable cardioverter device.
      1. PA chest radiograph
9. Post-interventional radiography.
  1. Pulmonary artery stent implant.
    1. Pulmonary artery stent implant.
      1. PA chest radiograph

  2. Coarctation stent implant.
    1. Coarctation stent implant.
      1. PA and lateral chest radiograph

  3. Atrial septal defect device closure.
    1. ASD occlusion device.
      1. PA chest radiograph

  4. Patent ductus arteriosus device closure.
    1. PDA coil occlusion.
      1. PA chest radiograph
    2. PDA sac occlusion.
      1. PA chest radiograph

      Image Review: Patent ductus arteriosus device closure.

  5. Aorto-pulmonary coil embolization.
    1. Aorto-pulmonary collateral coil embolization.
      1. PA chest film

  6. SVC stent implant.
    1. SVC stent implant.
      1. PA chest radiograph

  7. Femoral vein stent implant.
    1. Femoral vein stent implant.
      1. Radiograph