A patient with known Eisenmenger syndrome undergoes chest X-ray. Which combination of findings is most characteristic?

• A Bilateral diffuse airspace consolidation with normal heart size
• B Left atrial enlargement with upper lobe blood diversion
• C Boot-shaped heart with absent pulmonary conus
• D Enlarged central pulmonary arteries with peripheral pruning and right ventricular enlargement ✓

Explanation

Eisenmenger syndrome is characterised radiologically by dilated central pulmonary arteries, abrupt tapering (pruning) of peripheral vessels due to pulmonary arterial hypertension, and right ventricular enlargement (uplifted cardiac apex). Left atrial enlargement and upper-lobe diversion are features of mitral stenosis/left heart failure. Boot-shaped heart with absent pulmonary conus is tetralogy of Fallot.

Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.