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Incidental Finding on MDCT of Patent Ductus Arteriosus: Use of CT and MRI to Assess Clinical Importance

Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop St., Rm. 4660 CHP MT, Pittsburgh, PA 15213-2582.

View larger version (74K): [in a new window]   Fig. 1A. —65-year-old woman with scleroderma, severe pulmonary artery hypertension, and cardiac murmur. Ao = aorta. AAo = ascending aorta, DAo = descending aorta, PA = pulmonary artery. MDCT images (pulmonary embolic protocol) obtained with mediastinal window settings (level, 400 H; width, 40 H) show markedly enlarged caliber of pulmonary artery and dilatation of ascending aorta (A) and tubular structure (black asterisk) abutting aorta with adjacent coarse calcifications (white arrow, B).

View larger version (68K): [in a new window]   Fig. 1B. —65-year-old woman with scleroderma, severe pulmonary artery hypertension, and cardiac murmur. Ao = aorta. AAo = ascending aorta, DAo = descending aorta, PA = pulmonary artery. MDCT images (pulmonary embolic protocol) obtained with mediastinal window settings (level, 400 H; width, 40 H) show markedly enlarged caliber of pulmonary artery and dilatation of ascending aorta (A) and tubular structure (black asterisk) abutting aorta with adjacent coarse calcifications (white arrow, B).

View larger version (34K): [in a new window]   Fig. 1C. —65-year-old woman with scleroderma, severe pulmonary artery hypertension, and cardiac murmur. Ao = aorta. AAo = ascending aorta, DAo = descending aorta, PA = pulmonary artery. With optimized window settings (level 400 H; width, 280 H), tubular structure (asterisk) can be seen abutting aorta. Unenhanced blood can be seen flowing from aorta to pulmonary artery via patent ductus arteriosus (PDA) (white arrow). Adjacent coarse calcifications are marked with black arrow.

View larger version (103K): [in a new window]   Fig. 1D. —65-year-old woman with scleroderma, severe pulmonary artery hypertension, and cardiac murmur. Ao = aorta. AAo = ascending aorta, DAo = descending aorta, PA = pulmonary artery. Oblique multiplanar reformation with optimized window settings (level, 400 H; width, 280 H) shows unenhanced blood flowing from less-opacified aorta to maximally enhanced pulmonary artery via PDA, forming "negative jet" (black arrow). Adjacent coarse calcifications are marked with white arrow. Appropriate window settings (level, 400 H; width, 280 H) are necessary to show jet.

View larger version (168K): [in a new window]   Fig. 1E. —65-year-old woman with scleroderma, severe pulmonary artery hypertension, and cardiac murmur. Ao = aorta. AAo = ascending aorta, DAo = descending aorta, PA = pulmonary artery. MDCT with volume-rendered 3D reconstruction shows aorta and pulmonary artery with PDA (white asterisk) connecting two and adjacent coarse calcifications (white arrow).

View larger version (123K): [in a new window]   Fig. 1F. —65-year-old woman with scleroderma, severe pulmonary artery hypertension, and cardiac murmur. Ao = aorta. AAo = ascending aorta, DAo = descending aorta, PA = pulmonary artery. On cardiac steady-state free precession MR images, axial plane (F) and sagittal plane (G) images show dephasing of blood (white arrows) in pulmonary artery caused by blood flow from aorta to pulmonary artery via PDA.

View larger version (143K): [in a new window]   Fig. 1G. —65-year-old woman with scleroderma, severe pulmonary artery hypertension, and cardiac murmur. Ao = aorta. AAo = ascending aorta, DAo = descending aorta, PA = pulmonary artery. On cardiac steady-state free precession MR images, axial plane (F) and sagittal plane (G) images show dephasing of blood (white arrows) in pulmonary artery caused by blood flow from aorta to pulmonary artery via PDA.

View larger version (108K): [in a new window]   Fig. 1H. —65-year-old woman with scleroderma, severe pulmonary artery hypertension, and cardiac murmur. Ao = aorta. AAo = ascending aorta, DAo = descending aorta, PA = pulmonary artery. Volume-rendered 3D-reconstruction gadolinium-enhanced MR angiogram shows aorta and pulmonary artery with PDA (asterisk) connecting the two.

View larger version (110K): [in a new window]   Fig. 1I. —65-year-old woman with scleroderma, severe pulmonary artery hypertension, and cardiac murmur. Ao = aorta. AAo = ascending aorta, DAo = descending aorta, PA = pulmonary artery. Ten months after PDA closure, MDCT (pulmonary embolic protocol) oblique multiplanar reconstruction with optimized window settings (level, 400 H; width, 280 H) shows that PDA occluder is in place (arrowhead) with adjacent calcifications (arrow). Absence of jet verifies functionality of occluder.

View larger version (68K): [in a new window]   Fig. 2A. —49-year-old man evaluated for questionable aortic root dilatation seen on transthoracic echocardiography. Ao = aorta. AAo= ascending aorta, DAo = descending aorta, PA = pulmonary artery, LV = left ventricle. Axial MDCT (aortic protocol) with mediastinal window settings (level, 400 H; width, 40 H) show thin tubular structure (asterisk) between ascending and descending aorta (A). This patent ductus arteriosus (PDA) has horizontal orientation, making it more obvious on axial images. Lower level (B) shows thin "positive jet" (arrow) of contrast media flowing from maximally enhanced aorta to less-opacified pulmonary artery.

View larger version (74K): [in a new window]   Fig. 2B. —49-year-old man evaluated for questionable aortic root dilatation seen on transthoracic echocardiography. Ao = aorta. AAo= ascending aorta, DAo = descending aorta, PA = pulmonary artery, LV = left ventricle. Axial MDCT (aortic protocol) with mediastinal window settings (level, 400 H; width, 40 H) show thin tubular structure (asterisk) between ascending and descending aorta (A). This patent ductus arteriosus (PDA) has horizontal orientation, making it more obvious on axial images. Lower level (B) shows thin "positive jet" (arrow) of contrast media flowing from maximally enhanced aorta to less-opacified pulmonary artery.

View larger version (78K): [in a new window]   Fig. 2C. —49-year-old man evaluated for questionable aortic root dilatation seen on transthoracic echocardiography. Ao = aorta. AAo= ascending aorta, DAo = descending aorta, PA = pulmonary artery, LV = left ventricle. Sagittal multiplanar reconstruction (C) with mediastinal window settings (level, 400 H; width, 40 H) and (D) with optimized window settings (level, 400 H; width, 280 H) show that contrast-enhanced PDA forms subtle "positive jet" (arrow) flowing through PDA (asterisk) from enhanced aorta to less-opacified pulmonary artery. Appropriate use of window settings is necessary to identify this subtle finding.

View larger version (62K): [in a new window]   Fig. 2D. —49-year-old man evaluated for questionable aortic root dilatation seen on transthoracic echocardiography. Ao = aorta. AAo= ascending aorta, DAo = descending aorta, PA = pulmonary artery, LV = left ventricle. Sagittal multiplanar reconstruction (C) with mediastinal window settings (level, 400 H; width, 40 H) and (D) with optimized window settings (level, 400 H; width, 280 H) show that contrast-enhanced PDA forms subtle "positive jet" (arrow) flowing through PDA (asterisk) from enhanced aorta to less-opacified pulmonary artery. Appropriate use of window settings is necessary to identify this subtle finding.

View larger version (133K): [in a new window]   Fig. 2E. —49-year-old man evaluated for questionable aortic root dilatation seen on transthoracic echocardiography. Ao = aorta. AAo= ascending aorta, DAo = descending aorta, PA = pulmonary artery, LV = left ventricle. Cardiac MRI steady-state free precession (cardiac MR SSFP) images. In axial image (E), horizontally oriented PDA (asterisk) is seen as tubular structure coursing between ascending and descending aorta. Axial image (F) and coronal image (G) cardiac MR SSFP show blood flow via the PDA (asterisk) from the aorta to the pulmonary artery causing dephasing (arrow) within pulmonary artery.

View larger version (128K): [in a new window]   Fig. 2F. —49-year-old man evaluated for questionable aortic root dilatation seen on transthoracic echocardiography. Ao = aorta. AAo= ascending aorta, DAo = descending aorta, PA = pulmonary artery, LV = left ventricle. Cardiac MRI steady-state free precession (cardiac MR SSFP) images. In axial image (E), horizontally oriented PDA (asterisk) is seen as tubular structure coursing between ascending and descending aorta. Axial image (F) and coronal image (G) cardiac MR SSFP show blood flow via the PDA (asterisk) from the aorta to the pulmonary artery causing dephasing (arrow) within pulmonary artery.

View larger version (143K): [in a new window]   Fig. 2G. —49-year-old man evaluated for questionable aortic root dilatation seen on transthoracic echocardiography. Ao = aorta. AAo= ascending aorta, DAo = descending aorta, PA = pulmonary artery, LV = left ventricle. Cardiac MRI steady-state free precession (cardiac MR SSFP) images. In axial image (E), horizontally oriented PDA (asterisk) is seen as tubular structure coursing between ascending and descending aorta. Axial image (F) and coronal image (G) cardiac MR SSFP show blood flow via the PDA (asterisk) from the aorta to the pulmonary artery causing dephasing (arrow) within pulmonary artery.

View larger version (106K): [in a new window]   Fig. 2H. —49-year-old man evaluated for questionable aortic root dilatation seen on transthoracic echocardiography. Ao = aorta. AAo= ascending aorta, DAo = descending aorta, PA = pulmonary artery, LV = left ventricle. Gadolimium-enhanced MR angiography. 3D volume rendering depicts the AO, PA, and horizontally oriented PDA (asterisk) connecting them.

View larger version (67K): [in a new window]   Fig. 3A. —79-year-old man who underwent MDCT angiography (pulmonary embolic protocol) with mediastinal window settings (level, 400 H; width, 40 H). Ao = aorta, AAo = ascending aorta, DAo = descending aorta, PA = Pulmonary artery. Axial image shows tubular structure (asterisk) below aortic arch suggestive of patent ductus arteriosus (PDA).

View larger version (81K): [in a new window]   Fig. 3B. —79-year-old man who underwent MDCT angiography (pulmonary embolic protocol) with mediastinal window settings (level, 400 H; width, 40 H). Ao = aorta, AAo = ascending aorta, DAo = descending aorta, PA = Pulmonary artery. Sagittal multiplanar reconstruction shows structure to be diverticulum (asterisk) originating from aorta with no connection to pulmonary artery.

View larger version (85K): [in a new window]   Fig. 3C. —79-year-old man who underwent MDCT angiography (pulmonary embolic protocol) with mediastinal window settings (level, 400 H; width, 40 H). Ao = aorta, AAo = ascending aorta, DAo = descending aorta, PA = Pulmonary artery. Sagittal multiplanar reconstruction with bone window settings (level, 2,500 H; width, 800 H), shows tiny calcified area abutting diverticulum (arrow).

View larger version (116K): [in a new window]   Fig. 4A. —72-year-old male trauma patient who underwent contrast-enhanced axial CT to assess thoracic involvement (single detector, 5-mm collimation) with mediastinal window settings (level, 400 H; width, 40 H). Ao = aorta, AAo = ascending aorta, DAo = descending aorta, PA = pulmonary artery. Tubular structure, which is patent ductus arteriosus (PDA) (asterisk), is seen below aortic arch. Bilateral pleural effusions and atelectasis are also seen.

View larger version (133K): [in a new window]   Fig. 4B. —72-year-old male trauma patient who underwent contrast-enhanced axial CT to assess thoracic involvement (single detector, 5-mm collimation) with mediastinal window settings (level, 400 H; width, 40 H). Ao = aorta, AAo = ascending aorta, DAo = descending aorta, PA = pulmonary artery. Sagittal multiplanar reconstruction shows that PDA (asterisk) connects aorta and pulmonary artery. Multiplanar reconstruction quality is degraded because collimation of source images was 5 mm on this study done with single-detector scanner.

View larger version (135K): [in a new window]   Fig. 4C. —72-year-old male trauma patient who underwent contrast-enhanced axial CT to assess thoracic involvement (single detector, 5-mm collimation) with mediastinal window settings (level, 400 H; width, 40 H). Ao = aorta, AAo = ascending aorta, DAo = descending aorta, PA = pulmonary artery. At higher level, subtle aortic flap (arrowhead) is identified. This patient had aortic tear in descending aorta, which was surgically corrected.

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