Differential Diagnosis for "Boot-Shaped" Heart on Chest X-Ray
Single Most Likely Diagnosis
- A) Tetralogy of Fallot: This condition is characterized by four main components: ventricular septal defect, pulmonary stenosis, right ventricular hypertrophy, and an overriding aorta. The "boot-shaped" heart, also known as coeur en sabot, is a classic radiographic finding in Tetralogy of Fallot due to the right ventricular hypertrophy which displaces the cardiac apex upwards, giving the heart its distinctive shape.
Other Likely Diagnoses
- None: The "boot-shaped" heart is quite specific to Tetralogy of Fallot. Other conditions may cause cardiac silhouette abnormalities, but they do not typically produce this exact shape.
Do Not Miss Diagnoses
- B) Transposition of the great arteries: Although not typically associated with a "boot-shaped" heart, transposition of the great arteries is a serious congenital heart defect that requires early diagnosis and treatment. It's crucial to consider this condition in the differential diagnosis of any congenital heart defect, even if the classic radiographic signs are not present.
- D) Coarctation of the aorta: Coarctation of the aorta involves narrowing of the aortic isthmus and can lead to significant morbidity if not diagnosed and treated. While it does not cause a "boot-shaped" heart, it's an important condition to rule out in the evaluation of congenital heart disease.
Rare Diagnoses
- C) Atrial septal defect: Atrial septal defects are typically associated with an enlarged cardiac silhouette due to right atrial and ventricular enlargement, but they do not characteristically produce a "boot-shaped" heart. This condition is less likely to be associated with the described radiographic finding but is included for completeness in the differential diagnosis of congenital heart defects.