Infracardiac total anomalous pulmonary venous return

Case contributed by Micheál Anthony Breen
Diagnosis certain


10 week old male patient presents with increased work of breathing.

Patient Data

Age: 10 weeks
Gender: Male

Mild cardiomegaly with upturned cardiac apex. Increased pulmonary blood flow with pulmonary venous congestion and diffuse prominence of the pulmonary interstitium. Trace right pleural effusion.

Loss of the anterior clear space in keeping with right heart enlargement.

Case Discussion

Echocardiogram confirmed a diagnosis of infracardiac TAPVR.

When assessing a chest radiograph in suspected congenital heart disease, there are two important questions to ask before forming a differential diagnosis:

  1. Is the child cyanotic or acyanotic?
  2. Is there increased or decreased pulmonary blood flow on chest x-ray?

This helps the radiologist formulate a differential diagnosis that should correlate with the echocardiographic findings.

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