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Radiological appearance of tetralogy of Fallot

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Chest radiology may show a normal sized or enlarged heart but with the apex above the diaphragm due to right ventricular hypertrophy and a concave left heart border because the main pulmonary artery is small. The cardiac silhouette has been likened to a wooden shoe (coeur en sabot). The lung fields are oligaemic, and the aortic arch may be seen on the right in up to half. Summarising the features: PA lateral

  • left atrium becomes enlarged, may see indentation carina splayed of oesophagus on barium swallow
  • enlarged left enlarged heart, normal ventricle apex down
  • enlarged right bulging right normal atrium heart border
  • right upturned apex, raised heart ventricle boot shaped heart border

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