CTICasesAtrial Septal Defect
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Imaging findings
PA chest radiograph shows mild dilation of the main pulmonary artery and diffuse, balanced enlargement of the pulmonary arteries and veins in both the upper and lower lung zones. The superior vena cava and azygos vein are not distended. Echocardiography with a microbubble study demonstrates a large atrial septal defect (ASD) with a significant left-to-right shunt.
Key takeaways
A 'balanced' distribution of pulmonary blood flow on a chest radiograph—characterized by symmetric dilation of upper and lower lobe vessels without distension of the superior vena cava or azygos vein—suggests an increased pulmonary blood volume without elevated central venous pressure. This mismatch between pulmonary and systemic venous volumes is a classic radiographic sign of a left-to-right shunt, such as an atrial septal defect.
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