PMC6147903_01
Plain chest x-ray from a 4-year-old child with transposition of the great arteries (D-TGA) and supra-cardiac total anomalous pulmonary venous connection (TAPVC). The supra-cardiac vertical vein (VV) and the enlarged right superior vena cava (SVC) are well delineated. This supra-cardiac shadow masked the narrow mediastinum commonly seen with TGA (black arrow head). Both the cardiac silhouette and the pulmonary vascular markings were normal, which is an unexpected finding in TAPVC (i.e. each anomaly corrects the hemodynamic abnormality caused by the other lesion.
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The appearance of the superior mediastinum was unusual in that, while the projection of the great vessels was narrower than normal, the overall width of the superior mediastinum was within normal limits due to the presence of increased opacity on both sides of the great vessels (Figure 1).
Left ventriculogram (LV) showing the origin of the main pulmonary artery (MPA) from the LV with intact ventricular septum (not profiled in this view).
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Cardiac catheterization and angiography confirmed the echocardiographic diagnosis (Figures 2,3).