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Remnants of Fetal Circulation: Appearance on MDCT in Adults

¹ Department of Radiology, Duke University Medical Center, Duke North, Rm. 1417, Erwin Rd., Durham, NC 27710.
² Department of Radiology, University Hospitals of Cleveland/Case Western Reserve University, Cleveland, OH 44106-5056.

View larger version (44K): [in a new window]   Fig. 1 —Schematic representation shows fetal circulation. Bright-red blood vessels carry oxygenated blood, and blue vessels carry deoxygenated blood. 1 = umbilical vein, 2 = ductus venosus, 3 = foramen ovale, 4 = ductus arteriosus, 5 = umbilical arteries, 6 = main portal vein, 7 = left portal vein, 8 = left hepatic vein, 9 = inferior vena cava, 10 = abdominal aorta, 11 = umbilicus, 12 = urinary bladder, 13 = placenta, 14 = liver.

View larger version (147K): [in a new window]   Fig. 2 —52-year-old woman with normal findings on MDCT of abdomen and pelvis. Curved planar reconstruction image shows ligamentum teres hepatis (straight white arrows), which courses in free margin of falciform ligament from umbilicus (curved white arrow) to left portal vein (straight black arrow). Also, note right (curved black arrow) and main (asterisk) portal veins.

View larger version (71K): [in a new window]   Fig. 3 —Schematic representation shows teres ligament (arrows) runs in free margin of falciform ligament; compare this figure with Figure 2.

View larger version (109K): [in a new window]   Fig. 4 —48-year-old man with cirrhosis and portal venous hypertension. Curved planar reconstruction image of MDCT data set shows dilated paraumbilical vein coursing in fissure of ligamentum teres hepatis (black arrow) along free margin of falciform ligament (white arrow).

View larger version (144K): [in a new window]   Fig. 5 —53-year-old man with variant of hepatic arterial blood supply. Contrast-enhanced axial MDCT image shows accessory left hepatic artery (arrows) originating from left gastric artery and coursing in fissure of ligamentum venosum.

View larger version (114K): [in a new window]   Fig. 6A —45-year-old woman with patent ductus venosus. (Reprinted from [14]) Contrast-enhanced axial CT scan reveals abnormal vein (arrow) connecting large left portal vein to inferior vena cava through fissure of ligamentum venosum.

View larger version (153K): [in a new window]   Fig. 6B —45-year-old woman with patent ductus venosus. (Reprinted from [14]) Portogram confirms patent ductus venosus (arrow). Note small right portal vein.

View larger version (86K): [in a new window]   Fig. 7A —64-year-old woman with lipomatous hypertrophy of interatrial septum. Axial contrast-enhanced CT image shows prominent interatrial fat (arrow).

View larger version (93K): [in a new window]   Fig. 7B —64-year-old woman with lipomatous hypertrophy of interatrial septum. Axial contrast-enhanced CT image obtained inferior to A shows mild aneurysm of prominent fossa ovalis (arrow), embryonic remnant of foramen ovale.

View larger version (116K): [in a new window]   Fig. 8 —62-year-old man with atrial flutter. Axial contrast-enhanced CT image shows bulging of atrial septum (arrow) into right atrium, which is consistent with aneurysm of fossa ovalis.

View larger version (84K): [in a new window]   Fig. 9 —62-year-old woman with left atrial mass. Axial CT image shows lobulated left atrial mass (arrowhead). Note close relationship of mass to fossa ovalis (arrow). At surgery, left atrial myxoma originating at fossa ovalis was confirmed.

View larger version (69K): [in a new window]   Fig. 10A —37-year-old woman with pulmonary hypertension and hypoxia. Axial contrast-enhanced CT image shows large right pulmonary artery embolus (arrow).

View larger version (83K): [in a new window]   Fig. 10B —37-year-old woman with pulmonary hypertension and hypoxia. Axial contrast-enhanced CT image shows small patent foramen ovale (arrow) confirmed at echocardiography.

View larger version (116K): [in a new window]   Fig. 11 —64-year-old man with stroke. Sagittal maximum-intensity-projection image confirms thrombus (arrow) crossing into left atrium via patent foramen ovale (arrowhead). These findings were confirmed at transesophageal echocardiography.

View larger version (138K): [in a new window]   Fig. 12A —72-year-old woman with pulmonary hypertension and echocardiographic findings suspicious for patent ductus arteriosus. Sagittal volume-rendered MDCT image shows heavily calcified patent ductus arteriosus (arrow). LPA = left pulmonary artery.

View larger version (89K): [in a new window]   Fig. 12B —72-year-old woman with pulmonary hypertension and echocardiographic findings suspicious for patent ductus arteriosus. Axial MDCT image obtained during dynamic contrast study at level of patent ductus arteriosus shows jet of unopacified blood from aorta entering main pulmonary artery (arrow).

View larger version (86K): [in a new window]   Fig. 12C —72-year-old woman with pulmonary hypertension and echocardiographic findings suspicious for patent ductus arteriosus. Axial MDCT image obtained inferior to B shows jet of unopacified blood (arrow) from aorta runs into enhanced pulmonary artery, which is confirmatory of patent ductus arteriosus.

View larger version (110K): [in a new window]   Fig. 13A —74-year-old woman who presented for preoperative assessment of aortic calcification. Coronal (A) and sagittal (B) reconstruction images of unenhanced MDCT data set show small residual patent ductus arteriosus (arrows).

View larger version (124K): [in a new window]   Fig. 13B —74-year-old woman who presented for preoperative assessment of aortic calcification. Coronal (A) and sagittal (B) reconstruction images of unenhanced MDCT data set show small residual patent ductus arteriosus (arrows).

View larger version (162K): [in a new window]   Fig. 14A —49-year-old man with abdominal pain who presented for MDCT of pelvis. Volume-rendered sagittal reconstruction image shows median umbilical ligament (thin arrows) as remnant of urachus coursing from urinary bladder (asterisk) to umbilicus (thick arrow).

View larger version (122K): [in a new window]   Fig. 14B —49-year-old man with abdominal pain who presented for MDCT of pelvis. Volume-rendered axial reconstruction image shows left medial umbilical ligament (dashed arrows) as remnant of left umbilical artery coursing from left internal iliac artery (thin straight arrow) to umbilicus. Also, note anterior portion of right medial umbilical ligament (curved arrow) and median umbilical ligament as remnant of urachus (thick straight arrow).

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