Case

Patient History

The patient is a 7-month-old girl who started with problem of stridor and aspiration at 4-month of age. Barium swallow showed episodes of penetration and aspiration of barium under fluoroscopy. Bronchoscopy also confirmed increased number of macrophages (Colombo count) in the bronchoalveolar lavage fluid. Left bronchomalacia was also detected. In January 1996, when she developed a pneumonia due to Respiratory Syncytial virus, her chest radiograph showed atelectasis of right upper lobe, hyperinflation, and evidence of leftward and anterior deviation of the trachea, suggesting presence of a right aortic arch with a retroesophageal component. The descending aorta was noted on the left. The combination of findings suggest the presence of a right circumflex aorta with aberrant left subclavian artery. This was confirmed on a contrast-enhanced CT. The MRI was performed in the axial and coronal planes to better visualize the anatomy and for 3D reconstruction prior to operation for excision of the vascular ring, formed by the right aortic arch, aberrant left subclavian artery, ligamentum arteriosum, and the pulmonary artery.

Contributions of Volumetric Imaging to Case Outcome

MPEG Movies

Original Axial MR

The original trans axial section MR data set of a patient with a right aortic arch. The volumetric data acquisition of 3mm thickness 1mm gap.

Original Coronal MR

The original coronal section MR data set of a patient with a right aortic arch. The volumetric data acquisition of 2.5mm thickness 0.5mm gap.

Shaded Surface Displays (SSDs)

Shaded Surface Displays (SSDs) are often useful to surgeons to gain preoperative knowledge about spatial relationships between cardiac and vascular structures. This movie shows how the right aortic arch, aberrant left subclavian artery and left pulmonary artery encircle and compress the trachea and esophagus.

Last modified: Wed Jun 2 11:40:07 CDT