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Radiology
Aortic Arch Anomalies
Built from Obstetric Imaging
What’s inside
8 sections · 65 slides
Overview
- What this deck covers
What an aortic arch anomaly is
Position, branching and why anyone cares
- The arch, in plain words
- So what counts as an anomaly?
- 0.1%
- Why the true number is unknown
- One scan view changed the picture
How the arch is built
The double aortic arch model, and where it goes wrong
- Start with two arches, not one
- What normally happens next
- Think of it as demolition
- Demolish a different segment, get a different anomaly
- The company they keep
The four anomalies you must know
Sorted by one question: is there a ring around the airway?
- One question sorts them all
- The three categories
- Right aortic arch: the mirror image
- 1 / 1000
- What comes with a right aortic arch
- Right arch with an aberrant left subclavian
- Why that combination closes a ring
- Double aortic arch
- 0.005-0.007%
- Why finding it before birth matters
- Aberrant right subclavian artery
- The commonest of the group
- Pulmonary sling
- The four side by side
What the baby feels
Silence, or a squeezed windpipe and gullet
- Two possible stories
- Which tube is being squeezed?
- Why symptoms wait until after birth
Making the diagnosis on ultrasound
One view, four patterns, and the shapes that name them
- Where you look
- The normal "V"
- Normal three-vessel and trachea view
- Colour Doppler close-up of the normal V
- Four shapes to memorise
- Spotting a right aortic arch
- Right aortic arch on the three-vessel and trachea view
- Spotting the aberrant left subclavian
- Right arch with aberrant left subclavian artery
- Kommerell diverticulum
- Spotting a double aortic arch
- Ascending aorta splitting into two arches
- The "Z" sign
- Double aortic arch on the three-vessel and trachea view
- Colour Doppler close-up of the Z sign
- Setting up to find an aberrant right subclavian
- Normal branch versus aberrant branch
- Aberrant right subclavian artery behind the trachea
- Do not mistake it for a vein
- The two classic signs
- Other imaging, and when
What to do about it
Before birth, after birth, and who reaches the operating table
- The prenatal work-up
- Following the pregnancy
- Does the pregnancy plan change?
- Risk after birth is not one number
- 50-70%
- What those babies present with
- Who gets surgery
- From scan to theatre
Wrapping up
What the referring clinician needs, and what to remember
- What the referring physician needs to know
- What decides the outlook
- Key points
- Five things to carry away
- References
- References (continued)
- Suggested readings
- Obstetric Imaging: Fetal Diagnosis and Care, 2nd Edition