A Rare Case of Uncorrected Tetralogy of Fallot With Right Hemitruncus in an Adult Survivor Highlighting the Role of Cardiac Computed Tomography

Figure 1. Chest radiograph of the patient Posteroanterior chest radiograph showing mild cardiomegaly with prominence of the right cardiac border (white block arrow) and slightly upturned cardiac apex (white arrow). There is marked concavity at the level of the pulmonary artery segment along the left heart border with loss of the normal 2nd mogul (black arrow). There is increased lung markings in the right lung (asterisk) with a prominent right descending pulmonary artery (black block arrow).

Figure 2. Cardiac CT demonstrating TOF morphology (a) Multislice Cardiac CT: (a) Axial 4- chamber view in diastole, showing subaortic VSD (star) with overriding of the aortic root (asterisk), right ventricular hypertrophy (white arrow) with crowding of papillary muscles. The RA appears dilated. There is a malignant course of the right coronary artery (RCA) between the RA and the aortic root (black arrow); (b) Multislice Cardiac CT: (b) Coronal image focusing on ventricular outflow tract showing marked infundibular stenosis (white arrow) and pulmonary atresia and overriding of the ascending aorta (AAo). Note is made of the RCA between the RA and the aortic root (black arrow). TOF-Tetralogy of Fallot, AAo-Ascending aorta, RA-Right atrium, RV- Right ventricle, LA-Left atrium, LV-Left ventricle, VSD-Ventricular septal defect.

Figure 3. Cardiac CT showing right Hemitruncus (a and b) Multislice Cardiac CT (a) Axial and (b) Sagittal (reformatted oblique) images showing anomalous origin of RPA from ascending aorta (white arrow); (b) Sagittal (reformatted oblique) images showing anomalous origin of RPA from ascending aorta (white arrow) with normal origin of the arch vessels (asterisks). (c) Volumetric reconstruction image showing the origin of the RPA from the Ascending aorta. RPA- right pulmonary artery, AAo- Ascending Aorta, DAo- Descending aorta, LV- Left ventricle.

Figure 4. Cardiac CT demonstrating atretic MPA with reformed LPA (a) Multislice Cardiac CT Axial and (b) coronal image showing non-opacified atretic MPA (block arrow). Multiple mediastinal and peribronchial MAPCAs are seen(asterisk), (c) Cardiac CT Axial image, arrow showing reformed small caliber left pulmonary artery (LPA) in left hilum (white arrow) via multiple MAPCAs (stars). RPA- right pulmonary artery, AAo- Ascending Aorta, DAo- Descending Aorta, MPA- Main pulmonary artery, SVC- Superior Vena Cava.

Figure 5. Cardiac CT demonstrating extensive mediastinal collaterals (a to c) Cardiac CT Axial images showing multiple extensive collaterals in the subcarinal, AP window, peribronchial, along the tracheal wall, mediastinal, bilateral hilar, and epicardial surface (block arrows). RPA- right pulmonary artery, AAo- Ascending Aorta, DAo- Descending Aorta, RPA- Right pulmonary artery, SVC- Superior vena cava.