case_images: PMC11098604_01
case_images: A 15-year-old male with Tetralogy of Fallot. (a) Dilated ascending aorta (white arrow) in axial section. (b) Large ventricular septal defect (black arrow) in axial section. (c) Overriding of aorta with ventricular septal defect (black dotted arrow) in coronal section. (d) Volume-rendered image with left-sided aortic arch (dotted white arrow).
case_images: CRIRA2024-3543906.001.jpg
case_images: PMC11098604_01_CRIRA2024-3543906.001.jpg
case_images: fig1
case_images: Pulmonary CTA shows the arch of the aorta is on the left side, the aorta is overriding, and dilated ascending aorta (Figure 1(a)); descending aorta is normal in caliber. A large ventricular septal defect was noted in the subaortic region (Figures 1(b) and 1(c)), with dilated right-side heart chambers. The arch of the aorta is left-sided (Figure 1(d)).
case_images: PMC11098604_02
case_images: A 9-month-old male with Tetralogy of Fallot with axial sections. (a) Large ventricular septal defect (short black arrow). (b) Small atrial septal defect (long black arrow). (c) Hypoplastic right pulmonary artery (white arrow) and absent left pulmonary artery. (d) Overriding of aorta with ventricular septal defect (black dotted arrow).
case_images: CRIRA2024-3543906.002.jpg
case_images: PMC11098604_02_CRIRA2024-3543906.002.jpg
case_images: fig2
case_images: On pulmonary CTA findings, a subaortic ventricular septal defect (Figure 2(a)) is seen. A small radiologically visible atrial septal defect is seen measuring 2 mm (Figure 2(b)). The normal pulmonary trunk is seen for a length of 21 mm and continues as the right main pulmonary artery (Figure 2(c)); the left pulmonary artery is not visualized. The aorta is overriding (Figure 2(d)).
case_images: PMC11098604_03
case_images: An 18-year-old male with Tetralogy of Fallot. (a) Modified Blalock-Taussig shunt (white arrow) in volume-rendered image. (b) Blocked modified Blalock-Taussig shunt (white arrowhead) in maximum intensity projection images. (c) Multiple aortopulmonary collateral arteries (black arrow), few collaterals at the inferior margin of lower ribs in coronal images. (d) Tubercular changes with calcified and cavities in bilateral upper lobes of the lung (white dotted arrow) in lung window coronal section.
case_images: CRIRA2024-3543906.003.jpg
case_images: PMC11098604_03_CRIRA2024-3543906.003.jpg
case_images: fig3
case_images: Pulmonary CTA findings show a visible shunt connecting the left pulmonary artery to the left subclavian artery (Figures 3(a) and 3(b)) with no flow and hypodense contents in the lumen, suggestive of a complete block. Major aortopulmonary collaterals (Figure 3(c)) are seen originating from the posterior and right lateral borders of the descending aorta and the anterior aspect of the lower thoracic aorta, causing collateralization along the inner and inferior margins of bilateral upper ribs with scalloping. On the reformed lung window (Figure 3(d)), noncontrast images show fibrotic areas with calcification and cavities are noted in the right upper lobe, right middle lobe, left upper lobe, and lateral and posterior basal segments of the right lower lobe, suggesting a recurrence of tubercular lesions.
case_images: PMC11098604_04
case_images: A 6-year-old male with Tetralogy of Fallot with axial sections. (a) Bilateral innominate veins (black double arrow). (b) Left-sided superior vena cava (black arrow). (c) Right-sided aortic arch (white arrow). (d) Bilateral hypoplastic but present pulmonary arteries (dotted black arrow).
case_images: CRIRA2024-3543906.004.jpg
case_images: PMC11098604_04_CRIRA2024-3543906.004.jpg
case_images: fig4
case_images: The pulmonary CTA shows both innominate veins draining into the left side and the superior vena cava (Figures 4(a) and 4(b)), which is draining into the right atrium after crossing to the right side. The arch of the aorta is seen on the right side (Figure 4(c)), with the thoracic aorta also seen on the right side of the midline and the abdominal aorta on the midline. The pulmonary trunk is seen originating from the right ventricle, the main pulmonary artery measures 13 mm in diameter, and the left pulmonary artery is mildly hypoplastic, as seen in its entire course (Figure 4(d)).