Question

Identify the condition in the X-ray given below.

• A. TGA
• B. TAPVC
• C. TOF
• D. Ebstein's anomaly

Hint:

Upturned apex, concave pulmonary bay, dark lungs, think of the shape of a boot.

Answer 1

The Correct Option is C

Pattern recognition: Boot-shaped heart plus dark lungs equals Tetralogy of Fallot.
The upturned cardiac apex comes from right ventricular hypertrophy, and the concave upper-left heart border comes from an underdeveloped pulmonary artery. Together they carve the coeur en sabot or boot shape. Because the right ventricular outflow is obstructed, less blood reaches the lungs, so the pulmonary vasculature looks sparse and the lung fields appear lucent.
Option elimination by silhouette: Egg-on-a-string with a thin vascular pedicle would be TGA. A snowman or figure-of-eight contour with plethoric lungs would be supracardiac TAPVC. A grossly dilated, wall-to-wall, box-like heart would be Ebstein's anomaly. None of those match a boot.
Pearl: Echocardiography confirms TOF, and elective repair is typically at 4 to 6 months.
Ref: Bailey and Love, 27th edition.