Staatz / Honnef / Piroth Pediatric Imaging

Direct Diagnosis in Radiology
1. Auflage 2007
ISBN: 978-3-13-258104-3
Verlag: Thieme
Format: EPUB
Kopierschutz: 6 - ePub Watermark

E-Book, Englisch, 368 Seiten, ePub

Dx-Direct is a series of eleven Thieme books covering the main subspecialties in radiology. It includes all the cases you are most likely to see in your typical working day as a radiologist. For each condition or disease you will find the information you need -- with just the right level of detail. Dx-Direct gets to the point: - Definitions, Epidemiology, Etiology, and Imaging Signs - Typical Presentation, Treatment Options, Course and Prognosis - Differential Diagnosis, Tips and Pitfalls, and Key References ...all combined with high-quality diagnostic images. Whether you are a resident or a trainee, preparing for board examinations or just looking for a superbly organized reference: Dx-Direct is the high-yield choice for you! The series covers the full spectrum of radiology subspecialties including: Brain Gastrointestinal Cardiac Breast Urogenital Spinal Head and Neck Musculoskeletal Pediatric Thoracic Vascular

Gundula Staatz, D. Honnef, W. Piroth, T. Radkow

Zielgruppe

Ärzte

Autoren/Hrsg.

Honnef, Dagmar

Piroth, Werner

Radkow, Tanja

Staatz, Gundula

Fachgebiete

• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Medizinische Fachgebiete Bildgebende Verfahren, Nuklearmedizin, Strahlentherapie Radiologie, Bildgebende Verfahren
• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Klinische und Innere Medizin Pädiatrie, Neonatologie

Inhaltsverzeichnis

1 Lung and Mediastinum
2 Cardiovascular System
3 Neck
4 Gastrointestinal Tract
5 Urogenital Tract
6 Musculoskeletal System
7 Central Nervous System

Leseproben

2 Cardiovascular System

Arteria Lusoria (Aberrant Right Subclavian Artery)

Definition

• Epidemiology

  Most common vascular malformation of the aortic arch • Prevalence is 0.5% of the normal population, 30% of individuals with Down syndrome.

• Etiology, pathophysiology, pathogenesis

  An aberrant right subclavian artery arising distal to the left subclavian artery • Usually courses posterior to the esophagus to the right side • Rarely courses between the trachea and esophagus • Rarely, with a right aortic arch, the left subclavian artery will cross to the contralateral side posterior to the esophagus • Dysphagia because of esophageal compression • Stridor from tracheal compression.

Imaging Sings

• Chest radiograph findings

  Usually normal.

• Barium swallow findings

  Lateral view shows typical posterior impression of the esophagus • A-P view shows slight left caudal impression of the esophagus in a right cranial direction.

• CT and MRI findings

  Images precisely visualize the vascular anatomy and surrounding mediastinal structures • Delineation of associated malformations • Conventional angiography is not required.

Clinical Aspects

• Typical presentation

  Usually asymptomatic (incidental finding) • Rarely dysphagia • Extremely rarely patients present with coughing and stridor from tracheal impression.

• Therapeutic options

  Surgical transsection and mobilization of the aberrant right subclavian artery • Reimplantation of the artery into the ascending aorta may be indicated in symptomatic cases.

• Complications

  Infants with dysphagia who refuse food can develop dystrophy • Tracheal compression can lead to pulmonary complications.

Differential Diagnosis

Aberrant left subclavian artery

– Posterior impression – A-P film shows right caudal impression of the esophagus in a left cranial direction

Duplication of the aortic arch

– Bilateral impression of the esophagus – The right arch is usually more developed than the left arch

Fig. 2.1 Arteria lusoria. Contrastenhanced CT. Right aortic arch, right descending aorta. The left subclavian artery courses posterior to the trachea and esophagus (gastric tube) to the left (arrow). Postoperative air inclusions secondary to sternotomy. Endotracheal tube.

Tips and Pitfalls

Do not neglect to visualize the esophagus in dystrophy of uncertain etiology and in recurrent bronchopulmonary infection.

Selected References

Bove T et al. Tracheobronchial compression of vascular origin. Review of experience in infants and children. J Cardiovasc Surg 2001; 42: 663–666.

Donnelly LF et al. Aberrant subclavian arteries: cross-sectional imaging findings in infants and children referred for evaluation of extrinsic airway compression. AJR Am J Roentgenol 2002;178:1269–1274

Ulger Z et al. Arteria lusoria as a cause of dysphagia. Acta Cardiol 2004; 59: 445–447

Double Aortic Arch

Definiton

• Epidemiology

  Accounts for 55% of vascular rings. Usually, there are no additional malformations.

• Etiology, pathophysiology, pathogenesis

  Persistent fourth branchial arterial arch • Two aortic arches arise from a single aorta • The arches join to form a single descending aorta • In 75% of cases, a left descending aorta is present • Each arch gives rise to a common carotid and a subclavian artery • In 80% of cases, the left arch is smaller, is further caudal, and courses anterior to the esophagus and trachea • The right arch usually courses posterior to the esophagus.

Imaging Signs

• Chest radiograph findings

  Tracheal compression (usually more severe on the right than left) • Tracheal stenosis and displacement • Paratracheal soft tissue may appear prominent.

• Barium swallow findings

  Broad horizontal impression at the level of T3 and T4 vertebrae • The A-P view shows bilateral esophageal compression • No longer indicated as a standard diagnostic study.

• CT and MRI findings

  CT angiography or MR angiography is indicated for preoperative planning • Visualization of double aortic arch and compression of esophagus and/or trachea • Multiplanar and 3D reconstructions have replaced conventional angiography.

Clinical Aspects

• Typical presentation

  Stridor • Dyspnea • Recurrent pneumonia in early childhood, occasionally immediately after birth • rarely dysphagia • Occasionally asymptomatic.

• Therapeutic options

  Thoracotomy with surgical transsection of the smaller arch.

• Course and prognosis

  Persistent respiratory problems due to tracheomalacia (aortopexy may be indicated).

• Complications

  Severe, life-threatening tracheal compression.

Fig. 2.2 a,b Double aortic arch. A-P (a) and lateral (b) views of barium swallow. Typical narrowing of the esophagus at the level of the aortic arch (arrows).

Differential Diagnosis

Right aortic arch with aberrant left subclavian artery

– Usually distinguishable only on cross-sectional images – Right retroesophageal aortic arch from which the left subclavian artery arises as the last branch of the abnormal arch – Ligamentum arteriosum extending from the descending aorta to the left pulmonary artery, compressing the trachea and esophagus

Aberrant origin of the left pulmonary artery

– Posterior tracheal compression on chest radiograph

Mediastinal tumor

– Further diagnostic workup with CT and/or MRI

Tips and Pitfalls

• – Missing an arteria lusoria on an equivocal chest radiograph.
• – Additional diagnostic studies are indicated wherever typical symptoms are present.

Selected References

Cerillo AG et al. Sixteen-row multislice computed tomography in infants with double aortic arch. Int J Cardiol 2005; 99: 191–194

Funabashi N et al. Images in cardiovascular medicine. Double aortic arch with a compressed trachea demonstrated by multislice computed tomography. Circulation 2004; 110: 68–69

Yilmaz M et al. Vascular anomalies causing tracheoesophageal compression: a 20-year experience in diagnosis and management. Heart Surg Forum 2003; 6: 149–152

Coarctation of the Aorta

Definition

• Epidemiology

  Accounts for 5–8% of all congenital heart defects • Sex predilection: Four times more common in boys than in girls.

• Etiology, pathophysiology, pathogenesis

  Stenosis at the junction of the aortic arch and descending aorta • Concentric hypertrophy of the left ventricle due to increase in systemic vascular resistance.

  • – Preductal: Infantile type • Long hypoplastic aortic segment distal to the origin of the brachiocephalic trunk • Often combined with cardiac anomalies • Usually associated with patent ductus arteriosus
  • – Postductal: Adult type • Short stenosis distal to the origin of the ductus arteriosus • Usually no cardiac anomalies • Often an incidental finding • Ductus arteriosus is usually obliterated.

  Arterial hypertension in the upper half of the body • Hypotension distal to the stenosis.

  Collaterals: From the subclavian artery to the intercostal arteries, anterior spinal artery, internal thoracic artery, lateral thoracic arteries, cervical arteries.

  Associated malformations: Bicuspid aortic valve (25–50% of cases), intracardiac anomalies (up to 30% of cases, e.g., ventricular septal defect), Turner syndrome (up to 36%), cerebral aneurysms, mycotic aneurysm distal to the coarctation, Shone complex (supravalvular mitral stenosis, “parachute” mitral valve, subaortic stenosis and coarctation of the aorta), additional anomalies of the supraaortic vessels.

Imaging Signs

• Chest radiograph findings

  Rib notching (>age 10) • Widening of the upper mediastinum to the right (dilation of the ascending aorta proximal to the stenosis) • “Triple” sign (notching of the left superior margin of the mediastinum at the junction of the aortic arch and...

Über Autor(innen)

Gundula Staatz, D. Honnef, W. Piroth, T. Radkow