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MDCT Evaluation of Thoracic Aortic Anomalies in Pediatric Patients and Young Adults: Comparison of Axial, Multiplanar, and 3D Images

¹ All authors: Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd., St. Louis, MO 63110.

View larger version (103K): [in a new window]   Fig. 1A. —Right aortic arch with aberrant left subclavian artery in 10-year-old girl with cough and suspected pneumonia. Chest radiograph showed mediastinal widening. In this case, accuracies for making correct diagnosis were 100% for all observers and image types. Enhanced axial CT image shows right aortic arch (R) with aberrant left subclavian artery (arrow).

View larger version (99K): [in a new window]   Fig. 1B. —Right aortic arch with aberrant left subclavian artery in 10-year-old girl with cough and suspected pneumonia. Chest radiograph showed mediastinal widening. In this case, accuracies for making correct diagnosis were 100% for all observers and image types. Enhanced axial CT image obtained slightly more cranially shows aberrant left subclavian artery (arrow) taking off from right aortic arch (R).

View larger version (107K): [in a new window]   Fig. 1C. —Right aortic arch with aberrant left subclavian artery in 10-year-old girl with cough and suspected pneumonia. Chest radiograph showed mediastinal widening. In this case, accuracies for making correct diagnosis were 100% for all observers and image types. Enhanced coronal multiplanar CT image shows right aortic arch (R) and aberrant left subclavian artery (S and arrows). C = carina, T = trachea, P = pulmonary artery.

View larger version (124K): [in a new window]   Fig. 1D. —Right aortic arch with aberrant left subclavian artery in 10-year-old girl with cough and suspected pneumonia. Chest radiograph showed mediastinal widening. In this case, accuracies for making correct diagnosis were 100% for all observers and image types. Enhanced anterior view of 3D volume-rendered image shows aberrant left subclavian artery (white arrow) arising as last branch from right aortic arch (R). Also noted is right subclavian artery (black arrow). RC = right common carotid artery, LC = left common carotid artery.

View larger version (133K): [in a new window]   Fig. 2A. —Double aortic arch in 17-year-old boy with wheezing and abnormal chest radiograph. Accuracies for diagnoses for all observers and image types were 100%. Axial lung window CT image obtained at thoracic inlet level shows normal size trachea (T) without evidence of compression. White arrows = bilateral subclavian arteries, black arrows = bilateral common carotid arteries, E = esophagus.

View larger version (134K): [in a new window]   Fig. 2B. —Double aortic arch in 17-year-old boy with wheezing and abnormal chest radiograph. Accuracies for diagnoses for all observers and image types were 100%. Axial lung window CT image obtained at midtracheal level shows both right (R) and left (L) limbs of double aortic arch surrounding trachea (T) and esophagus (E). At this level, bilateral tracheal compression is present.

View larger version (135K): [in a new window]   Fig. 2C. —Double aortic arch in 17-year-old boy with wheezing and abnormal chest radiograph. Accuracies for diagnoses for all observers and image types were 100%. Coronal lung window multiplanar image shows bilateral compression of mid trachea (T) by right (R) and left (L) limbs of double aortic arch.

View larger version (132K): [in a new window]   Fig. 2D. —Double aortic arch in 17-year-old boy with wheezing and abnormal chest radiograph. Accuracies for diagnoses for all observers and image types were 100%. 3D luminogram of airway shows mild tracheal narrowing (arrowheads) caused by double aortic arch. T = trachea.

View larger version (107K): [in a new window]   Fig. 3A. —Postductal aortic coarctation of aorta in 17-day-old neonate boy with cyanosis and left upper extremity hypertension. Enhanced axial CT image shows very subtle discrepancy in sizes of ascending aorta (A) and descending aorta (D). Vessel narrowing graded correctly by one reviewer. All confidence scores were 4.

View larger version (137K): [in a new window]   Fig. 3B. —Postductal aortic coarctation of aorta in 17-day-old neonate boy with cyanosis and left upper extremity hypertension. Enhanced sagittal multiplanar image clearly shows short, high-grade coarctation involving descending aorta (arrow). Correct diagnosis made by all observers. Confidence level for each observer was 5. AA = ascending aorta, DA = descending aorta.

View larger version (78K): [in a new window]   Fig. 3C. —Postductal aortic coarctation of aorta in 17-day-old neonate boy with cyanosis and left upper extremity hypertension. Enhanced sagittal 3D volume-rendered image shows descending aortic coarctation (short straight arrow). Also noted, are aberrant right subclavian artery (open arrows) arising just distal to aortic coarctation, left common carotid artery (long straight arrow), right common carotid (curved arrow), and right vertebral artery (arrowhead) arising from right common carotid artery. Correct diagnosis made by all observers. Confidence levels for each observer was 5. AA = aortic arch, DA = descending aorta, LSC = left subclavian artery.

View larger version (99K): [in a new window]   Fig. 3D. —Postductal aortic coarctation of aorta in 17-day-old neonate boy with cyanosis and left upper extremity hypertension. Enhanced posterior view of 3D volume-rendered image shows aortic coarctation (solid arrow) involving descending aorta (DA). This image also shows full course of aberrant right subclavian artery (open arrows) which arises just distal to area of coarctation.

View larger version (114K): [in a new window]   Fig. 4A. —Tracheal narrowing in 17-year-old boy with a right arch with an aberrant left subclavian artery. Accuracies for diagnoses for all observers and image types were 100%. Axial CT image obtained at lung window shows mild compression of right tracheal wall. RA = right aortic arch, LSC = aberrant left subclavian artery, T = trachea.

View larger version (116K): [in a new window]   Fig. 4B. —Tracheal narrowing in 17-year-old boy with a right arch with an aberrant left subclavian artery. Accuracies for diagnoses for all observers and image types were 100%. Coronal multiplanar image shows focal compression (arrowhead) of right tracheal wall adjacent to right aortic arch. T = trachea.

View larger version (92K): [in a new window]   Fig. 4C. —Tracheal narrowing in 17-year-old boy with a right arch with an aberrant left subclavian artery. Accuracies for diagnoses for all observers and image types were 100%. Three-dimensional volume-rendered image confirms the focal compression (arrow).

View larger version (101K): [in a new window]   Fig. 5A. —Patent ductus arteriosus in 2-year-old boy with murmur on physical examination. Patent ductus arteriosus was suspected and CT was subsequently performed. Enhanced axial CT image fails to show patent ductus arteriosus between aorta (A) and pulmonary artery (P). This image was interpreted as normal by all three observers. Confidence level was 5 in all three cases.

View larger version (105K): [in a new window]   Fig. 5B. —Patent ductus arteriosus in 2-year-old boy with murmur on physical examination. Patent ductus arteriosus was suspected and CT was subsequently performed. Enhanced sagittal multiplanar image shows small patent ductus arteriosus (arrows) between aorta (A) and pulmonary artery (P). Correct diagnosis was made by only one observer. Confidence level was 5 in all cases.

View larger version (94K): [in a new window]   Fig. 5C. —Patent ductus arteriosus in 2-year-old boy with murmur on physical examination. Patent ductus arteriosus was suspected and CT was subsequently performed. Enhanced sagittal 3D volume-rendered image depicts patent ductus arteriosus (arrow) and its relationship to pulmonary artery (P) and aorta (A). Correct diagnosis was made by two observers. Confidence level was 5 in all cases.

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