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Radiology
Tetralogy of Fallot
Built from Obstetric Imaging
What’s inside
9 sections · 57 slides
Overview
- What you will learn here
What the defect is
One misplaced wall, four consequences
- Start with the normal heart
- The one wall that sits wrong
- Tetralogy means a set of four
- Why the fourth feature is missing in the fetus
- From one misplaced wall to every sign you see
- 1 in 3600
- Common at birth, missed before it
Causes and company
What triggers it, and what travels with it
- What causes it
- Always think genetics
- What else to look for once you have found it
- The extra scan findings, explained
Three variants, three stories
Sorted by how badly the way out to the lungs is blocked
- The condition splits three ways
- Variant one: narrowed way out to the lungs
- Variant two: the way out is sealed shut
- The block can tighten as pregnancy goes on
- Variant three: no working pulmonary valve
The fetus and the newborn
Silent inside, then everything changes at birth
- Nothing to feel before birth
- Two very different newborns
Finding it on ultrasound
Three views, in order
- The scanning sequence
- A normal-looking heart that is not normal
- A heart pointing too far to the left
- Enlarged heart in the absent pulmonary valve form
- What to notice in that enlarged heart
- The view that makes the diagnosis
- Hole in the septum with the aorta straddling it
- Y-shaped colour flow into the aortic root
- Reading the Y sign
- Why the aorta grows and the lung artery does not
- Question-mark sign with the lungs fed backwards
- The question-mark sign, and how much it is worth
- A small pulmonary artery splitting in two
- The three-vessel and trachea view
- The three variants side by side on colour Doppler
- Forward flow through a narrowed pulmonary trunk
- Reversed flow filling the pulmonary artery
- Massively dilated pulmonary branches
- What the absent valve form looks like here
- Aortic arch running right of the windpipe
- The classic signs, in one place
Look-alikes
Three defects that also show a vessel over a hole
- Sorting an overriding vessel
- Malalignment ventricular septal defect
- Double outlet right ventricle
- Common arterial trunk
- Three findings that point to a common trunk
Before and after birth
Counselling, surveillance and surgery
- What to do the day you diagnose it
- What to tell the parents
- The road after birth
- What the surgeon does
- When the baby cannot wait
Take it away
What the referring doctor needs, and the three lines to remember
- What the referring physician needs to know
- What the referring physician needs to know
- Three lines to carry away
- References
- References (continued)
- Suggested readings
- Obstetric Imaging: Fetal Diagnosis and Care, 2nd Edition