Developmental Aortic Arch Anomalies in Infants and Children Assessed With CT Angiography

Ramos-Duran, Luis; Nance, John W.; Schoepf, U. Joseph; Henzler, Thomas; Apfaltrer, Paul; Hlavacek, Anthony M.

doi:10.2214/ajr.11.6982

Cited by 52 publications

(40 citation statements)

References 13 publications

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“…Multidetector CT is excellent for assessment of vascular rings because of its rapid acquisition and high spatial resolution [4,13,14]. Cardiac gating is not typically used, and exams are performed with suspended respiration or quiet breathing [3,[14][15][16].…”

Section: Ct and Mrimentioning

confidence: 99%

“…Automated bolus tracking is performed with the region of interest in the vessel of interest, with the trigger value set at 100-150 HU. Reducing the kVp to 70-80 in infants and young children has a double benefit of reducing patient dose and also bringing the beam energy closer to the k-edge of iodine [3,14,16,17], improving tissue contrast. These parameters provide maximal vascular enhancement for optimal 3-D volume-rendered images, maximum-intensity projection images, and multiplanar reformatted images [13].…”

Section: Ct and Mrimentioning

confidence: 99%

“…Steady-state free precession (SSFP) imaging, when performed with respiratory triggering, cardiac gating, and high-resolution technique, can be used to generate a 3-D dataset. Multiplanar reformatted images along vascular planes can be used to define vascular relationships and analyze airway compromise [3,5,14,[16][17][18]. Multiphase T1-weighted contrastenhanced MR angiography and time-resolved MR angiography are also useful for 3-D acquisitions when performed with thin slices (1.5-2 mm) to improve reconstruction.…”

Section: Ct and Mrimentioning

confidence: 99%

“…3) or the arches are symmetrical in size. As with all vascular rings, the symptoms of a double aortic arch are secondary to compression of the trachea and esophagus [4,14,16] but this anomaly tends to produce a tighter ring with earlier presentation. Preoperative identification of the smaller arch is necessary for thoracotomy planning [12] because surgical ligation is typically performed on the smaller arch and the commonly ipsilateral ligamentum arteriosum [4][5][6]19].…”

Section: Vascular Rings Sign 1: Double Aortic Archmentioning

confidence: 99%

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Useful signs for the assessment of vascular rings on cross-sectional imaging

et al. 2015

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Vascular rings can be challenging to diagnose because they can contain atretic portions not detectable with current imaging modalities. In these cases, where the compressed airway and esophagus are not encircled by patent, opacified vessels, there are useful secondary signs that should be considered and should raise suspicion for the presence of a vascular ring. These signs include a double aortic arch, the four-vessel sign, the distorted subclavian artery sign, a diverticulum of Kommerell, a ductal diverticulum contralateral to the aortic arch, and a descending aorta contralateral to the arch or circumflex aorta. If none of these findings is present, a ring can be excluded with confidence.

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Section: Ct and Mrimentioning

confidence: 99%

Section: Ct and Mrimentioning

confidence: 99%

Section: Ct and Mrimentioning

confidence: 99%

Section: Vascular Rings Sign 1: Double Aortic Archmentioning

confidence: 99%

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Useful signs for the assessment of vascular rings on cross-sectional imaging

et al. 2015

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“…Many are associated with cardiovascular anomalies or gastroesophageal symptoms (rings and slings) and thus tend to be discovered early in life [1,2]. Many others however are either isolated or otherwise asymptomatic.…”

Section: Introductionmentioning

confidence: 99%

Aortic Arch Variants: A Practical Guide to Safe and Timely Catheterization

2018

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Background: Variations in aortic arch anatomy have been extensively described from multiple perspectives including gross anatomy, embryology, associated cardiac and other anomalies, early life presentation, and cross-sectional diagnosis. There is however a paucity of literature with an emphasis on safe and timely catheterization, particularly when the variants are found during emergent or other catheter angiographic procedures without benefit of prior cross-sectional vascular imaging. The purpose of this review is to try to fill this gap. Methods: A review of past 1,000 diagnostic and therapeutic catheterizations was performed to identify arch variants, which are presented in order of frequency encountered at our institutions. Results: The variants are presented as illustrations and catheter angiographic images, with emphasis on safe and efficient intraprocedural diagnosis and catheterization. Conclusion: Familiarity with more and less common arch variants, along with low threshold for performance of pigtail aortic arch angiography and comfort in use of general purpose and recurved catheters, will ensure success in the vast majority of encountered variations.

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