🩻 TOACS FCPS Station · Chest X‑ray: Ventricular Septal Defect (VSD)
📷 Chest X‑ray (PA view)
🔍 Key radiographic features:
- ✓ Cardiomegaly – enlarged cardiac silhouette (cardiothoracic ratio >50%)
- ✓ Left ventricular enlargement – apex displaced downwards and to the left
- ✓ Left atrial enlargement – convex left atrial border
- ✓ Increased pulmonary vascularity – prominent pulmonary arteries
- ✓ Pulmonary plethora – vascular markings extending to lung periphery
📋 Clinical scenario (examiner prompt)
A 5‑year‑old girl was referred from routine school medical services after a heart murmur was detected. She is asymptomatic, has no history of cyanosis, and is growing well. On examination, there is a loud, harsh holosystolic murmur at the left lower sternal border with a palpable thrill. The chest X‑ray (PA view) is shown.
🧑⚕️ Examiner tasks · TOACS
1. Identify the diagnosis from the X‑ray and clinical context.
2. Describe the X‑ray findings (cardiomegaly, LV/LA enlargement, increased pulmonary vascularity).
3. Interpret the murmur – location, quality, and clinical significance.
4. Discuss management and natural history (spontaneous closure, follow-up).
🎯 Expected answers (for examiners)
- • Diagnosis: Ventricular septal defect (VSD) – likely perimembranous or muscular, small to moderate size
- • X‑ray: Cardiomegaly (enlarged LV and LA), increased pulmonary vascularity (pulmonary plethora)
- • Murmur: Harsh holosystolic at LLSB with thrill; indicates restrictive defect with high velocity shunt
- • Management: Asymptomatic → observation, echocardiography to assess size and hemodynamics; high chance of spontaneous closure (muscular 80%, perimembranous 30-50%)
⚡ Quick FCPS‑style MCQ
A 5‑year‑old with a loud holosystolic murmur at LLSB with thrill, asymptomatic, normal growth. The murmur intensity suggests:
A. Large VSD with equal ventricular pressures B. Small, restrictive VSD with high pressure gradient C. Eisenmenger syndrome D. Pulmonary stenosis📌 Topic summary ·
VSD (25-30% of all CHD)
Harsh holosystolic at LLSB ± thrill
Cardiomegaly, increased pulmonary vascularity
Perimembranous (80%), Muscular (5-20%)
Muscular 80%, Perimembranous 30-50%
Large VSD at 2-6 weeks of life
| Feature | Small VSD | Large VSD |
|---|---|---|
| Murmur | Loud, holosystolic with thrill | Soft, may have no thrill |
| Symptoms | Asymptomatic | Heart failure, FTT |
| CXR | Normal or mild cardiomegaly | Cardiomegaly, pulmonary plethora |
| Spontaneous closure | Common (50-80%) | Uncommon |
| Management | Observation | Surgical closure |