Question

Pulmonary plethora is seen with all of the following except:

• A. Transposition of the great arteries (TGA)
• B. Ebstein anomaly
• C. Hypoplastic left heart syndrome
• D. Double outlet right ventricle

Hint:

Which lesion obstructs right-sided flow and gives oligemic lung fields?

Answer 1

The Correct Option is B

Split the options into increased versus decreased pulmonary flow. Admixture lesions such as transposition of the great arteries, hypoplastic left heart syndrome and double outlet right ventricle dump extra blood into the lungs, so the chest film shows plethora. Ebstein anomaly is different: the tricuspid valve is displaced into the right ventricle, right-sided output falls, and blood shunts right to left across the atrial septum. The result is reduced pulmonary blood flow with oligemic lung fields and a strikingly enlarged, box-shaped heart. So the one that does NOT show plethora, and is the answer to this "except" question, is Ebstein anomaly.