Which radiographic finding is classic for Tetralogy of Fallot?

• A. Boot-shaped heart
• B. Egg-shaped heart
• C. Normal heart size
• D. Snowman sign

Answer: (A)

Tetralogy of Fallot produces a distinctive chest X-ray appearance because of right ventricular hypertrophy and a relatively small pulmonary arterial segment from pulmonary stenosis. This combination makes the cardiac silhouette take on a boot-like shape: the apex is rotated upward and the main body appears tapered, giving the characteristic “boot” look. This radiographic finding is classic for TOF and reflects the underlying pathophysiology of reduced pulmonary flow with compensatory right ventricular enlargement.

Other options don’t fit TOF. A snowman sign is associated with total anomalous pulmonary venous return, not TOF. A normal heart size would miss the structural changes, and an egg-shaped heart is not the typical TOF pattern.