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Case of the week # 522
August 6, 2020 - August 27, 2020

1. Maternité Isaïe Jeanty et Léon Audain, Chancerelles, Haïti

As usual, our friend and colleague Javier Cortejoso sent us the best and more detailed answer possible!

The following grayscale and color Doppler images demonstrate a tortuous Ductus Arteriosus (Also called Ductal aneurysm):

 

Grayscale image of a tortuous Ductus Arteriosus 

 

Change in flow direction and increased velocity (aliasing) demonstrated by color Doppler

 


3-Vessel-Trachea View demonstrating a tortuous Ductus Arteriosus and a persistent Left Superior Vena Cava (LSVC).

The Ductus Arteriosus is a blood vessel segment that connects the main pulmonary trunk to the proximal descending aorta. It plays a vital role in fetal circulation as it allows the majority of the deoxygenated blood coming from the right ventricle to bypass the fetal lungs and join the thoracic aorta. 50% of the blood flowing through the thoracic aorta returns to the placenta (via the umbilical arteries) where oxygenation occurs.

A tortuous Ductus Arteriosus, with an S-configuration, toward the end of gestation (late third trimester) is considered a normal finding with no clinical implications, as Ductus Arteriosus aneurysms resolve spontaneously in postnatal life. Nonetheless, a small group of infants develop complications such as thrombo-embolism, and compression of nearby thoracic structures. Postnatal evaluation is therefore recommended in this group.

Sources:
Abuhamad, A.Z., Chaoui, R. (2016). A practical guide to fetal echocardiography: Normal and abnormal hearts (3rd ed.). Philadelphia, PA: Wolters Kluwer.
Ganesan, S., Hutchinson, D.P., Sampson, A.J. (2015). Prenatal diagnosis of ductus arteriosus aneurysm. Ultrasound, 23(4), 251-253.

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