Tetralogy of Fallot

  • Etiology: Congenital
  • Imaging: Right to left shunt and right ventricular outflow obstruction leads to cyanosis and decreased pulmonary blood flow
  • Imaging CXR: Boot shaped heart with upward pointing cardiac apex due to right ventricular hypertrophy and decreased pulmonary blood flow
  • Imaging:
    — Four components include ventricular septal defect, pulmonary stenosis (right ventricular outflow obstruction), overriding aorta, right ventricular hypertrophy
    — Right arch in 20%
  • Note: In Tetralogy of Fallot with pulmonary atresia there is no luminal continuity, so there is no flow between right ventricle and pulmonary artery, so blood leaves right ventricle via ventricular septal defect
  • DDX:
  • Complications:
  • Treatment:
  • Clinical:
    — Most common cyanotic congenital heart disease
    — Right sided obstructed lesion with neonatal ductal dependence

Radiology Cases of Tetralogy of Fallot

CXR of tetralogy of Fallot
CXR AP shows decreased pulmonary blood flow, a right-sided aortic arch and an upturned cardiac apex resulting in a boot-shaped heart.
CXR of tetralogy of Fallot / TOF
CXR AP shows decreased pulmonary vascularity and a normal sized heart with the cardiac apex slightly upturned.