Situs abnormalities associated with congenital heart diseases: tips for successful CTA imaging and diagnosis.

Congress:

ECR 2019

Poster Number:

C-2681

Type:

Educational Exhibit

Keywords:

Congenital, Education, Diagnostic procedure, Computer Applications-3D, CT-Angiography, CT, Paediatric, Cardiovascular system

Authors:

L. Musayeva, Y. Efendiyev; Baku/AZ

DOI:

10.26044/ecr2019/C-2681

DOI-Link:

https://dx.doi.org/10.26044/ecr2019/C-2681

Fig. 1

Fig. 2

Fig. 3: Native locator images showing an abnormal anatomy and complexity to choose...

Fig. 4: Right isomerism (Ivemark syndrome) case. (A) Chest scanogram showing bilateral...

Fig. 5: F-anisosplenia case with dextrocardia, bilateral two-lobed lungs and bifurcated...

Fig. 6: Situs inversus case. Status after total DORV and pulmonary stenosis correction...

Learning objectives

To review types of situs abnormalities. To give tips for an accurateCTA evaluationof paediatric patients withvisceral situs abnormality associated with cardiovascular anomalies. To describe step-by step theirCT characterization by usingsegmental approachof assessment of all organ and systems in the field of view.

Background

Visceroatrial situs refers to the position and configuration of the cardiac atria, the tracheobronchial tree, and the thoracoabdominal viscera[1]. Situs solitus with a trilobed right lung and a bilobed left lung, normal position of atria, levocardia with levoversion, liver on the right side of upper abdomen and stomach and spleen on the left side is the normal anatomic position of the thoracic and abdominal organs [2]. In situs solitus, the right upper lobe bronchus is superior and posterior to the descending branch of the right...

Findings and procedure details

Findings: Case 1. 6-year old male patient with right isomerism (Ivemark syndrome), dextrocardia, atrioventricular (AV) canal defect, main pulmonary artery atresia and severe pulmonary stenosis, bilateral 3-lobed lungs, midline liver, asplenia, IVC juxtaposition (status after left sided BT shunt 4 years ago and Glenn procedure 3 years ago). Fig. 4 Case 2. 1-year old female patient with situs inversus, dextrocardia, VSD, overriding aorta, RVOT infundibular stenosis, main, right and left pulmonary arteries hypoplasia (Fallot Tetralogy). Case 3. 6-year old female patient with situs inversus, dextrocardia,...

Conclusion

CTA with a dose optimisation can be an excellent non-invasive tool for an accurate assessment of the cardiac and extra-cardiac structures to avoid delay in diagnosis and management of patients (mostly pediatric population) with situs abnormalities associated with complex CHD when other modalities such as MRI is not available or contraindicated. For proper management of patients with situs anomalies associated with CHD, radiologist should be able to perform the correct interpretation of CTA results and in detail describe all changes.

Personal information

L. Musayeva, MD Republican Medical DiagnosticCentre,Department of Radiology 147, Tbilisi ave, Baku, Azerbaijan AZ 1122 Phone: +994503597279 Work phone: +994125309029 (131) Fax: +994125308318 e-mail :[email protected]

References

1. Ghosh S, Yarmish G, Godelman A, Haramati LB, Spindola-Franco H. Anomalies of visceroatrial situs. AJR Am J Roentgenol. 2009;193(4):1107-17. 2. Jacobs JP, Anderson RH, Weinberg PM, Walters HL, Tchervenkov CI, Del Duca D, et al. The nomenclature, definition and classification of cardiac structures in the setting of heterotaxy. Cardiol Young. 2007;17 Suppl 2:1-28. 3. Applegate KE, Goske MJ, Pierce G, Murphy D. Situs revisited: imaging of the heterotaxy syndrome. Radiographics. 1999;19(4):837-52; discussion 53-4. 4. Shogan PJ, Folio L. Situs inversus totalis. Mil Med. 2011;176(7):840-3....