ABSTRACT

Larry Elliott and Gerold Schiebler 1 (then at University of Florida) in their book, The X-ray Diagnosis of Congenital Heart Disease in Infants, Children, and Adults, ascribe this distinct sign of pulmonary shunt vascularity (Figure 1) to Kent Ellis. Shunt vascularity is another one of the key findings to look for when evaluating the chest radiograph in cases of congenital heart disease (see Egg shaped heart, Mogul shadow and Shmoo shaped heart). In the book, Elliott reported that the most common congenital heart condition prone to show the ‘waterfall right hilum’ sign is transposition of the great vessels with a single ventricle. 1 ‘The other complex lesions [transposition, tricuspid atresia, truncus arteriosus], most notably complete transposition with a large [ventricular septal defect] VSD, may uncommonly show the same finding … the so-called ‘waterfall right hilum’ sign. It is produced by the combination of torrential and increased pulmonary flow plus an elevation of the right pulmonary artery (RPA) itself. The elevation of the RPA is caused by massive dilatation of the pulmonary trunk, which, in turn, causes an uplifting of the RPA.’ 1 ‘Cyanosis and shunt with elevated right pulmonary artery (RPA) (waterfall hilum).’ Reprinted from <italic>The X-ray Diagnosis of Congenital Heart Disease in Infants, Children and Adults</italic> by Elliot and Schiebler (1979)<xref ref-type="bibr" rid="ref93_1"> <sup>1</sup> </xref>, with permission. Courtesy of Charles C. Thomas, Publisher, Springfield, II https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9781003076568/34c29fd5-5662-4e8f-b58c-badd7fa5d724/content/fig93_1_B.jpg"/>