The pulmonary vascularity in patients with pulmonary atresia and ventricular septal defect

Pulmonary vascularity in patients with pulmonary atresia and ventricular septal defect varies widely and depends on the anatomic and functional status of the main pulmonary artery and the left and right pulmonary arteries in their central, hilar and intrapulmonary segments. In pulmonary atresia and ventricular septal defect, there are three main patterns of pulmonary vascularity seen on the plain chest radiograph: 1, diminished pulmonary vascularity; 2, plethora with increased pulmonary blood flow often associated with horizontal arteries suggesting aortopulmonary collaterals; and 3, asymmetric vascularity indicating stenosis within the pulmonary arterial tree. A mottled appearance at the periphery of the lungs represents pleural-pulmonary collateral circulation. The anatomic and functional status of the pulmonary circulation can be demonstrated by opacification of the channels that supply the pulmonary arterial system either by selective or nonselective methods or through pulmonary venous wedge retrograd...