Question

Pulmonary plethora is seen with all of the following except:

• A. Transposition of the great arteries (TGA)
• B. Ebstein anomaly
• C. Hypoplastic left heart syndrome
• D. Double outlet right ventricle

Hint:

Which lesion obstructs right-sided flow and gives oligemic lung fields?

Answer 1

The Correct Option is B

Step 1: Pulmonary plethora means increased pulmonary blood flow, seen with left-to-right shunts or admixture lesions that overload the pulmonary circulation.
Step 2: Transposition of the great arteries, hypoplastic left heart syndrome and double outlet right ventricle are admixture or shunt lesions that typically show increased pulmonary vascular markings (plethora).
Step 3: Ebstein anomaly causes obstruction to right-sided flow with a right-to-left shunt across the atrial septum, so the lung fields are oligemic (decreased pulmonary blood flow), not plethoric. It also produces the classic massive cardiomegaly with the "box-shaped" heart.
Conclusion: Ebstein anomaly is the exception.
Ref: Nelson Textbook of Pediatrics.