Case of the Week #559

Azar Farajov
Azerbaijan

Posting Dates: May 15 - May 30, 2022

28-year-old woman (G3P2), with non-contributive history, presented to our office at 19 weeks + 3 days of her pregnancy. Following images and videos show an interesting cardiac anomaly that we found during our examination.

Image 1 ©2022 Azer Farajov
Image 2 ©2022 Azer Farajov
Image 3 ©2022 Azer Farajov
Image 4 ©2022 Azer Farajov
Image 5 ©2022 Azer Farajov
Image 6 ©2022 Azer Farajov
Image 7 ©2022 Azer Farajov
Video 1 ©2022 Azer Farajov
Video 2 ©2022 Azer Farajov
Video 3 ©2022 Azer Farajov

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Answer

Current COW represented a case of left aortic arch and right ductus arteriosus making so called "cross ribbon sign" [1].

Four-chamber-view of the heart
Image 1 Four-chamber-view of the heart ©2022 Azer Farajov
Transverse scan of the thorax at the level of the aortic arch. Ao - aorta; SVC - Superior Vena Cava
Image 2 Transverse scan of the thorax at the level of the aortic arch. Ao - aorta; SVC - Superior Vena Cava ©2022 Azer Farajov
Three-vessel-trachea view of the heart showing pulmonary artery (PA), ascending aorta (Ao), superior vena cava (SVC), descending aorta (DAo), right pulmonary artery (RPA)
Image 3 Three-vessel-trachea view of the heart showing pulmonary artery (PA), ascending aorta (Ao), superior vena cava (SVC), descending aorta (DAo), right pulmonary artery (RPA) ©2022 Azer Farajov
Three-vessel-trachea view of the heart showing pulmonary artery (PA), RIGHT DUCTUS ARTERIOSUS (RDA), ascending aorta (Ao), superior vena cava (SVC), descending aorta (DAo)
Image 4 Three-vessel-trachea view of the heart showing pulmonary artery (PA), RIGHT DUCTUS ARTERIOSUS (RDA), ascending aorta (Ao), superior vena cava (SVC), descending aorta (DAo) ©2022 Azer Farajov
Three-vessel-trachea view of the heart showing pulmonary artery (PA), RIGHT DUCTUS ARTERIOSUS (RDA) making a vascular sling around trachea and connecting to the descending aorta (DAo), ascending aorta (Ao), superior vena cava (SVC)
Image 5 Three-vessel-trachea view of the heart showing pulmonary artery (PA), RIGHT DUCTUS ARTERIOSUS (RDA) making a vascular sling around trachea and connecting to the descending aorta (DAo), ascending aorta (Ao), superior vena cava (SVC) ©2022 Azer Farajov
Color Doppler: three-vessel-trachea view - pulmonary artery (PA), RIGHT DUCTUS ARTERIOSUS (RDA) making a vascular ring around trachea and connecting to the descending aorta (DAo). Ascending aorta (Ao), superior vena cava (SVC).
Image 6 Color Doppler: three-vessel-trachea view - pulmonary artery (PA), RIGHT DUCTUS ARTERIOSUS (RDA) making a vascular ring around trachea and connecting to the descending aorta (DAo). Ascending aorta (Ao), superior vena cava (SVC). ©2022 Azer Farajov
Drawing of the "cross ribbon sign" type of vascular ring. Right ductus arteriosus (RDA), left aortic arch (LAA). LPA - left pulmonary artery, RPA - right pulmonary artery, DA - descending aorta.
Image 7 Drawing of the "cross ribbon sign" type of vascular ring. Right ductus arteriosus (RDA), left aortic arch (LAA). LPA - left pulmonary artery, RPA - right pulmonary artery, DA - descending aorta. ©Frantisek Grochal
Drawing of the "cross ribbon sign" type of vascular ring. Right ductus arteriosus (RDA), left aortic arch (LAA). LPA - left pulmonary artery, RPA - right pulmonary artery, DA - descending aorta.
Image 8 Drawing of the "cross ribbon sign" type of vascular ring. Right ductus arteriosus (RDA), left aortic arch (LAA). LPA - left pulmonary artery, RPA - right pulmonary artery, DA - descending aorta. ©Frantisek Grochal

References:

1. Vijayaraghavan SB, Senthil S, Latha K. Prenatal diagnosis of a rare aortic arch anomaly with left aortic arch and right ductus arteriosus: Cross ribbon sign. Indian J Radiol Imaging. 2017;27(1):70-72. doi:10.4103/0971-3026.202963

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