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Radiological appearance of tetralogy of Fallot

Last reviewed Jan 1, 2018

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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