This document provides an overview of how different congenital heart diseases appear on chest x-rays. It describes the typical enlargements seen in different cardiac chambers and pulmonary vasculature for various conditions. For example, it notes that the right atrium is commonly enlarged in Ebstein's anomaly and atrial septal defects, while the left atrium may be enlarged in ventricular septal defects or patent ductus arteriosus. The document also discusses abnormalities in heart shape, such as a "boot"-shaped silhouette in tetralogy of Fallot. Overall, it serves as a guide for interpreting chest x-ray findings in the context of congenital heart disease.

1. X ray of the week Prof. S. TITO`s Unit

3. CX ray in ASD Cardiomegaly 1.RA enlarged LA seldom enlarged – mostly in elderly 2.RV enlarged,forms apex 3.All chambers enlarged in large shunt 4.Localized enlargement of SVC attachment – in sinus venosus type

4. Pulmonary Vasculature - increased pul artery and venous vasculature up to peripheries - enlarged pulmonary trunk (jughandle) and its main branches. Ascending Aorta rarely forms the heart border

5. CXR in Congenital heart Disease Need PA and Lateral views Find Heart size,position and silhouette Enlargement of specific cardiac chamber Pulmonary vasculature other structures

6. HEART SIZE AND SILHOUETTE Cardiomegaly - Epstein's anomaly, later stages of shunt lesions and shunt reversals Silhouette TOF – boot Persistent truncusarteriosus. Sitting duck shape Ebstein anomaly. Box-shaped, square heart TAPVC(supracardiac) Snowman, figure of 8 TGA egg-shaped or apple on a string Corrected TGA

7. ENLARGEMENT OF INDIVIDUAL CHAMBER Lt Atrial Enlargement : Ventricular septal defect, Patent ductusarteriosus Atrialseptal defect with shunt reversal ASD with tricuspid atresia Aortopulmonary window Lt Ventricle Enlargement Ventricular septal defect Patent ductusarteriosus, Aortopulmonary window, Atrioventricular canal

8. ENLARGEMENT OF INDIVIDUAL CHAMBER RtAtrial Enlargement Ebstein’s anomaly Atrialseptal defect Atrioventricular canal Pulmonary hypertension TAPVC Sinus of Valsalva fistula congenital tricuspid stenosis or atresia Rt Ventricle Enlargement Left-to-right shunt Idiopathic pulmonary hypertension Pulmonary arteriovenous malformations pulmonary stenosis

9. PULMONARY VASCULATURE Pulmonary Plethora Acyanotic – ASD, VSD, PDA, Endocardial cushion defects, partial TAPVC Cyanotic –TGA, TAPVR, hypoplastic left heart syndrome, persistent truncusarteriosus, a single ventricle Pulmonary Olgaemia Tricuspid atresia, Tetralogy of Fallot Ebstein’sanomaly,Pulmonarystenosis, Uncorrected transposition with PVS, Eisenmenger reaction PULMONARY VENOUS CONGESTION TAPVR, cortriatriatum Normal Pul Vasculature Pulmonary art stenosis small Lt to Rt shunt