Ductus arteriosus: more than just the patent ductus arteriosus.

The ductus arteriosus is important to fetal circulation. Failure to close at birth is a common event. In this educational pictorial essay, we illustrate the association of the ductus arteriosus with a variety of congenital cardiac, vascular and pulmonary lesions. These lesions can impact the systemic circulation, the pulmonary circulation or the airway and include coarctation of the aorta, ductal origin of the pulmonary artery and vascular rings.

Imaging of a carotid aneurysm in two patients following extracorporeal membrane oxygenation therapy.

Following extracorporeal membrane oxygenation (ECMO), two patients subsequently developed carotid aneurysms at the site of cannulation. Given the invasive nature of ECMO, vascular ultrasound and/or computerized tomographic imaging should be considered to rule out cannulation-site complications post-ECMO.

Radiographic Detectability of Retained Neuropatties in a Cadaver Model.

BACKGROUND: Counts are the commonest method used to ensure that all sponges and neuropatties are removed from a surgical site before closure. When the count is not reconciled, plain radiographs of the operative site are taken to determine whether the missing patty has been left in the wound. The purpose of this study was to describe the detectability of commonly used neuropatties in the clinical setting using digital technologies. METHODS: Neuropatties were implanted into the anterior and posterior cranial fossae and the thoracolumbar extradural space of a mature male cadaver. Four neuropatty sizes were used: 3 × 1 in, 2 × ½ in, ½ × ½ in, and » × » in. Neuropatties, with size and location chosen at random, were placed in the surgical sites and anteroposterior/posterior-anterior and lateral radiographs were taken using standard portable digital radiographic equipment. Six clinicians reviewed the digital images for the presence or absence of neuropatties. The readers were not aware of the number and size of the patties that were included in each image. RESULTS: The detectability of neuropatties is dependent on the size of the neuropatty's radiopaque marker and the operative site. Neuropatties measuring 2 × ½ in and 3 × 1 in were detected reliably regardless of the operative site. » × » in neuropatties were poorly detected by neurosurgeons and radiologists in all three operative sites. Readers of various experience and background were similar in their ability to detect neuropatties under these conditions. CONCLUSIONS: Under simulated operating room conditions and using currently available neuropatties and plain radiograph imaging technology, small »-in and ½-in neuropatties are poorly visible/detectable on digital images.

Congenital heart defects and coronary anatomy.

Coronary artery anomalies are a well recognized feature of many cardiac malformations and have been catalogued in a number of reviews. This overview concentrates on 1) the interplay between congenital heart defects and coronary morphogenesis, examining how some of the embryology fits with the experiments of nature encountered in clinical practice; and 2) the influence of coronary anatomy on patient management. This overview uses, as examples, pulmonary atresia with intact ventricular septum, complete and congenitally corrected transpositions of the great arteries, and tetralogy of Fallot.

Utilization of ultrasound for the detection of pneumothorax in the neonatal special-care nursery.

Pneumothorax is a potentially life-threatening condition in the setting of the neonatal special-care nursery (SCN) that may result in rapid deterioration and death. The familiar appearances associated with pneumothorax on AP supine chest radiograph are highly specific, but limited in sensitivity. In this case report, we describe the theory and technique of thoracic ultrasound for detection of pneumothorax in the SCN, providing a viable alternative to the cross-table lateral radiograph without ionising radiation, with highly accurate results, and with minimal patient positioning.

Repair in infancy of right aortic arch with aberrant left brachiocephalic artery in the setting of a variant of the hypoplastic left heart syndrome.

A right aortic arch, with a retroesophageal transverse arch and an aberrant left brachiocephalic artery, is a rare anomaly by itself. When combined with severe mitral stenosis and hypoplasia of the left ventricle, it is rarer still. We describe the diagnosis and treatment of this rare anomaly in an infant using a modification of the Norwood operation.