Diagnosis and management of congenital vascular rings: Efficacy of prenatal sonography and enhanced-computed tomography

DOI
  • Fujiwara Shintaro
    Department of Pediatrics, National Hospital Organization Fukuyama Medical Center
  • Araki Tooru
    Department of Pediatrics, National Hospital Organization Fukuyama Medical Center
  • Yamashita Sadanori
    Department of Pediatrics, National Hospital Organization Fukuyama Medical Center
  • Kitada Kunimi
    Department of Pediatrics, National Hospital Organization Fukuyama Medical Center
  • Fujiwara Michimasa
    Department of Pediatrics, National Hospital Organization Fukuyama Medical Center
  • Iwase Mizue
    Department of Pediatrics, National Hospital Organization Fukuyama Medical Center
  • Kodera Aya
    Department of Pediatrics, National Hospital Organization Fukuyama Medical Center
  • Inotani Motohiro
    Department of Pediatrics, National Hospital Organization Fukuyama Medical Center
  • Miyahara Daisuke
    Department of Pediatrics, National Hospital Organization Fukuyama Medical Center

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Other Title
  • 血管輪の診断・管理における胎児エコーと造影CTの有用性の検討

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Abstract

<p>Background: Vascular rings are congenital vascular anomalies that encircle and compress the trachea and esophagus. They have been increasingly detected by prenatal sonography in recent years. However, it is sometimes difficult to detect them accurately. We review the diagnostic imaging, clinical outcomes and management of our experience with vascular rings.</p><p>Methods: Four patients with vascular rings were identified by prenatal sonography, and enhanced-computed tomography (CT) was used for further investigation after their birth. We retrospectively studied these 4 cases.</p><p>Results: One patient was diagnosed with a right aortic arch, left brachiocephalic artery and left ductus arteriosus (RAA·LBCA·LDA), and the others were diagnosed with a right aortic arch, aberrant left subclavian artery and left ductus arteriosus (RAA·ALSA·LDA) by prenatal sonography. All patients were asymptomatic in the neonatal period. The patient with RAA·LBCA·LDA and one of the patients with RAA·ALSA·LDA had episodes of stridor associated with viral infection at the age of 1 month and 4 months, respectively. Enhanced-CT revealed a double aortic arch in the patient with RAA·LBCA·LDA and Kommerell diverticulum in all the patients with RAA·ALSA·LDA. Two patients with symptoms underwent surgical treatment, and their symptoms improved.</p><p>Conclusion: Prenatal sonography is an effective screening method for vascular rings but evaluating vascular structures accurately can be difficult in some cases. In such cases, enhanced-CT can provide detailed information. In particular, enhanced-CT should be performed if the possibility of DAA cannot be excluded by prenatal sonography. Making a diagnosis of asymptomatic vascular rings by prenatal sonography can provide treatment early when they become symptomatic.</p>

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