case_images: PMC11705528_01
case_images: An AP frontal radiograph showing an enlarged cardiac shadow, cardiothoracic ration of 0.7 and widened superior mediastinum, patchy rounded opacities in the para-cardiac area bilaterally. The rest of the bony ribcage as normal, no defects seen.
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case_images: An initial chest radiograph was requested by the primary pediatrician and revealed significant cardiomegaly with patchy lung infiltrates bilaterally (Figure 1).
case_images: (a, b) shows computed tomography angiography images coronal reformat and axial slices respectively showing the globally enlarged heart with cardiothoracic ratio of 0.76, with a Ventral Septal Defect (VSD) noted in the coronal image, as well as the increased thickness of the right ventricular wall of 1.61 cm in the axial image. LV, left ventricle; RV, right ventricle.
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case_images: The CTA confirmed the DORV and VSD identified on echocardiography, showing a cardiothoracic ratio of 0.76 and hypertrophy of the right ventricular wall measuring 1.61 cm (Figure 2).
case_images: (a, b) shows chest computed tomography angiography coronal reformats at different sections showing the aorta (Ao) arising entirely from the right ventricle (RV), the main pulmonary trunk (MPA) arising from both the right ventricle and the left ventricle (LV) due to a large mid-septum ventricular septal defect (VSD) which measured 9.49 mm giving the double outlet right ventricle diagnosis. We also see that the MPA is twice the size of the aorta with the MPA: Ao of 2.4:1.
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case_images: In addition, the CTA detected anatomic anomalies including double superior vena cavae, a severely hypoplastic mid and distal aortic arch (Figure 4), and an enlarged main pulmonary artery that was approximately twice the diameter of the aorta, leading to an MPA-to-Ao ratio of 2.4:1 (Figure 3).
case_images: Computed tomography angiography axial slice at the level of the aortic arch showing severely hypoplastic mid and distal arch as compared to the ascending and descending thoracic aorta that measured 1 cm. There is also a left sided superior vena cava in addition to the normally placed right sided superior vena cava (SVC).
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case_images: In addition, the CTA detected anatomic anomalies including double superior vena cavae, a severely hypoplastic mid and distal aortic arch (Figure 4), and an enlarged main pulmonary artery that was approximately twice the diameter of the aorta, leading to an MPA-to-Ao ratio of 2.4:1 (Figure 3).
case_images: Computed tomography angiography axial slice at the level of the great vessels showing the enlarged main pulmonary trunk (MPA), double superior vena cavae (SVC) and a patent ductus arteriosus between the MPA and the Descending thoracic aorta.
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case_images: ccr370076-fig-0005
case_images: A patent ductus arteriosus between the main pulmonary trunk (MPA) and the descending thoracic aorta was also observed (Figure 5).