free-downloads CSEVideos


Spot Diagnosis - Infant CXR

Discussion in 'Spot Diagnosis' started by neo_star, Feb 3, 2013.

  1. neo_star

    neo_star Moderator

    Joined:
    Nov 4, 2012
    Messages:
    775
    Likes Received:
    184
    Trophy Points:
    1,545
    Practicing medicine in:
    India

    [​IMG]
     

    Add Reply

    Attached Files:


  2. bb100

    bb100 Bronze Member

    Joined:
    Jun 7, 2012
    Messages:
    450
    Likes Received:
    54
    Trophy Points:
    845
    first diagnosis Mediastinal teratoma . second diagnosis tymoma. thoracic CT study is necessary
     

    neo_star likes this.
  3. neo_star

    neo_star Moderator

    Joined:
    Nov 4, 2012
    Messages:
    775
    Likes Received:
    184
    Trophy Points:
    1,545
    Practicing medicine in:
    India
    I agree with the differentials.

    Hint: This is a vascular anomaly.
     

  4. bb100

    bb100 Bronze Member

    Joined:
    Jun 7, 2012
    Messages:
    450
    Likes Received:
    54
    Trophy Points:
    845
    Anomalous left pulmonary artery (pulmonary artery sling)?
     

    neo_star likes this.
  5. neo_star

    neo_star Moderator

    Joined:
    Nov 4, 2012
    Messages:
    775
    Likes Received:
    184
    Trophy Points:
    1,545
    Practicing medicine in:
    India
    I am going to have to permit that as a correct answer...becos with an anomalous left pulmonary artery ( due to failure of left 6th aortic arch ) the left pul art originates from the rt. pul art and pushes the trachea to the right. You may get some wheezing with pulmonary artery sling, esp on the rt. side, because the rt main bronchus is compressd but you won't get stridor.

    pulmonary sling.JPG

    This CXR should give U the hint.

    [​IMG]
     

  6. kangourou

    kangourou Famous Member

    Joined:
    May 14, 2011
    Messages:
    91
    Likes Received:
    43
    Trophy Points:
    395
    Practicing medicine in:
    France
    From the barium swallow above, this is a double aortic arch. I agree that the top image could easily have been a pulmonary sling, but as neo-star said it wouldn't explain the stridor
     

    neo_star likes this.
  7. Emergency medicine Mike

    Emergency medicine Mike Bronze Member

    Joined:
    Jul 28, 2012
    Messages:
    839
    Likes Received:
    38
    Trophy Points:
    1,245
    Gender:
    Male
    Practicing medicine in:
    Czech Republic
    Pulmonary artery sling.
     

  8. neo_star

    neo_star Moderator

    Joined:
    Nov 4, 2012
    Messages:
    775
    Likes Received:
    184
    Trophy Points:
    1,545
    Practicing medicine in:
    India
    Answer: Double aortic Arch

    [​IMG]

    Credit to Dr. bb100 for initiating a good discussion and providing very valid differentials and to Dr. kangourou for clinching the diagnosis.

    We only think of solid masses in our differentials for mediastinal masses...the idea of posting this challenge was to induce some thought into vascular rings being one of the differentials for mediastinal masses causing a widened mediastinum or mediastinal shift.



    (Y)
     

    Last edited: Feb 4, 2013
  9. neo_star

    neo_star Moderator

    Joined:
    Nov 4, 2012
    Messages:
    775
    Likes Received:
    184
    Trophy Points:
    1,545
    Practicing medicine in:
    India
    Related Self Assessment Question

    A newborn infant displays wheezing respiration, which is aggravated when she feeds, flexes her neck, and/or cries. Radioimaging studies of her chest reveal a double aortic arch compressing her trachea and esophagus. This rare developmental defect results from persistence of the right dorsal aorta, which normally disappears. The arch of the aorta arises from which of the following structures?

    A. fifth pair of aortic arches
    B. fourth pair of aortic arches
    C. second pair of aortic arches
    D. sixth pair of aortic arches
    E. third pair of aortic arches

    EXPLANATION:

    The arch of the aorta is formed from the left fourth aortic arch. Part of the right fourth aortic arch becomes the proximal portion of the right subclavian artery, whereas the rest of the fourth arch disappears. However, if it persists, a right aortic arch is formed passing posterior to the trachea and esophagus. With the formation of the normally occurring left aortic arch, which runs anterior to the trachea and esophagus, a double aortic arch is created. This defect clamps the trachea and esophagus resulting in the respiratory symptoms.

    The second pair of aortic arches (choice C) partially form the stapedial arteries in the middle ear of the embryo.

    The third pair of aortic arches (choice E) form the common carotid arteries and contribute to the internal carotid arteries.

    The fifth pair of aortic arches (choice A) either does not develop or form primitive vessels, which disappear eventually.

    The sixth pair of aortic arches (choice D) contribute to the formation of the pulmonary arteries and ductus arteriosus.

    The answer is B.


    [​IMG]
     

  10. neo_star

    neo_star Moderator

    Joined:
    Nov 4, 2012
    Messages:
    775
    Likes Received:
    184
    Trophy Points:
    1,545
    Practicing medicine in:
    India
    Animation explaining the development of aortic arch vessels

    [​IMG]
     

    Last edited: Feb 18, 2013

Share This Page

<