PMC6031205_01
Portable X-ray which shows an absence of the aortic knob (arrow) and inability to visualize the descending aorta, suggestive of a right-sided aortic arch.
CRIPE2018-7412869.001.jpg
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fig1
Chest X-ray could not view the aortic knob or descending aorta well and could not rule out a right-sided aortic arch (Figure 1).
2D image in the subcostal right anterior oblique plane ("Tet view") demonstrating the large VSD produced by anterior and superior malalignment of the infundibulum, which completely obstructs the RVOT producing profound cyanosis and the need for an emergent BT shunt. PV, MPA, and branches are hypoplastic, each measuring approximately 3 mm at the time of presentation. RA: right atrium, LA: left atrium, IAS: interatrial septum, TV: tricuspid valve, RV: right ventricle, LV: left ventricle, VSD: ventricular septal defect, RVOT: right ventricular outflow tract, PV: pulmonary valve, MPA: main pulmonary artery, RPA: right pulmonary artery, and LPA: left pulmonary artery.
CRIPE2018-7412869.002.jpg
PMC6031205_01_CRIPE2018-7412869.002.jpg
fig2
Repeat TTE confirmed the diagnosis of Tetralogy of Fallot with severe pulmonary stenosis, hypoplastic main and branch pulmonary arteries, right-sided aortic arch, and small secundum atrial septal defect (Figure 2).