<prompt> All of the following are features of chest radiography in Tetralogy of fallot except: September 2007Boot shaped hea shadowIn 80 right sided arch of aoaOligemic lung fieldsRight ventricular enlargement  <response>: Ans. B: In 80 right sided arch of aoa Findings associated with TOF: Right ventricular predominance on palpation May have a bulging left hemithorax Systolic thrill at the lower left sternal border Aoic ejection click Single S2 - Pulmonic valve closure not heard Systolic ejection murmur More cyanotic patients have greater obstruction and a softer murmur. An acyanotic patient with tetralogy of Fallot pink tetralogy has a long, loud, systolic murmur. Cyanosis and clubbing - Variable Squatting position Scoliosis - Common Retinal engorgement Chest roentgenography - Coeur en sabot boot-shaped hea secondary to uplifting of the cardiac apex from right ventricular hyperophy and the absence of a normal main pulmonary aery - Normal hea size due to the lack of pulmonary blood flow and congestive hea failure Decreased pulmonary vascularity - Right atrial enlargement - Right-sided aoic arch 30 of patients with indentation of leftward-positioned tracheobronchial shadow - May be normal in acyanotic tetralogy of Fallot or may resemble findings of small-sized to moderate-sized ventricular septal defect VSD with mild right ventricular hyperophy, right atrial enlargement, and increased pulmonary vascular markings Echocardiography: Reveals a large VSD with an overriding aoa and variable degrees of right ventricular outflow tract RVOT obstruction 