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Development of a Perigraft Seroma Around Modified Blalock-Taussig Shunts

Imaging Evaluation

Rick R. van Rijn1, Rolf M. F. Berger2, Maarten H. Lequin1 and Simon G. F. Robben3

1 Department of Paediatric Radiology, Sophia Children's Hospital, University Hospital Rotterdam, Ste. D-205, P. O. Box 2040, 3000 CA Rotterdam, The Netherlands.
2 Present address: Department of Radiology, Academic Medical Center Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam Zuid-Oost, The Netherlands.
3 Department of Paediatric Cardiology, Sophia Children's Hospital, University Hospital Rotterdam, 3000 CA Rotterdam, The Netherlands.
4Department of Radiology, University Hospital Maastricht, P. O. Box 5800, 6202 AZ Maastricht, The Netherlands.



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  		Fig. 1. —Schematic drawing of original Blalock-Taussig shunt on patient's right side and modified Blalock-Taussig shunt on left side.

 


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  		Fig. 2A. —Anteroposterior chest radiographs obtained in 1-month-old male neonate after placement of modified Blalock-Taussig shunt. Radiograph obtained 7 days after surgery shows density (arrow) in right upper lobe, fitting with diagnosis of infection, atelectatis, or perigraft seroma development.

 


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  		Fig. 2B. —Anteroposterior chest radiographs obtained in 1-month-old male neonate after placement of modified Blalock-Taussig shunt. Radiograph obtained 20 days after surgery shows increasingly spherical density (arrow) in right upper lobe, suggestive of perigraft seroma development.

 


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  		Fig. 3A. —Sonograms in girl 2 years 4 months old obtained 11 days after placement of modified Blalock-Taussig shunt. Gray-scale image of perigraft seroma shows anechoic zone (arrow) with zone of intermediate reflection surrounding modified Blalock-Taussig shunt (arrowhead).

 


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  		Fig. 3B. —Sonograms in girl 2 years 4 months old obtained 11 days after placement of modified Blalock-Taussig shunt. Color-flow image of perigraft seroma (curved arrow) shows flow in modified Blalock-Taussig shunt (arrowhead) and subclavian artery (straight arrow).

 


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  		Fig. 3C. —Sonograms in girl 2 years 4 months old obtained 11 days after placement of modified Blalock-Taussig shunt. Gray-scale image of atelectatic lung shows heterogeneous tissue with mixed echogenicity.

 


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  		Fig. 3D. —Sonograms in girl 2 years 4 months old obtained 11 days after placement of modified Blalock-Taussig shunt. Color-flow image of atelectatic lung shows strong vascular signals.

 


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  		Fig. 4A. —CT scans obtained 12 days after placement of modified Blalock-Taussig shunt in same girl imaged in Figure. 3A,3B,3C,3D. Unenhanced CT scan shows fluid collection of intermediate density (arrow) surrounding modified Blalock-Taussig shunt (arrowhead).

 


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  		Fig. 4B. —CT scans obtained 12 days after placement of modified Blalock-Taussig shunt in same girl imaged in Figure. 3A,3B,3C,3D. On CT scan obtained after administration of IV contrast medium, fluid collection (curved arrow) shows no enhancement, whereas perigraft seroma wall (straight arrow) and modified Blalock-Taussig shunt (arrowhead) show definite enhancement.

 


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  		Fig. 5A. —MR images obtained 20 days after placement of modified Blalock-Taussig shunt in 1-year-2-month-old female infant with perigraft seroma. Coronal T1-weighted image shows well-delineated isointense mass (arrow) adjacent to modified Blalock-Taussig shunt.

 


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  		Fig. 5B. —MR images obtained 20 days after placement of modified Blalock-Taussig shunt in 1-year-2-month-old female infant with perigraft seroma. T2-weighted image shows hyperintense lesion (arrow) with modified Blalock-Taussig shunt with flow void (arrowhead), indicating patency of shunt.

 

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