X-Ray - ASD

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

2. 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

3. 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

4. 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

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

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

7. ENLARGEMENT OF INDIVIDUAL CHAMBER Rt Atrial Enlargement Ebstein’s anomaly Atrial septal 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

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

9. OTHER STRUCTRES : Location of the liver and gastric fundus Aorta identification – Rt arch – TOF, Truncus arteriosus “Figure 3” sign – Coarctation of aorta Skeletal – Rib notching(mostly 4 & 8 th ribs)- COA >5yrs Upper Mediastinum – prominent thymus – appears cardiomegaly (Sail sign) Absent Thymus – TGA other – vessels – TAPVC – snowman sign Pulmonary Parenchyma – see for evidence of infection

10. THANK YOU