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An Abnormal Blood Vessel in a Fetus at 22 Weeks of Gestation
Journal of Medical Ultrasound (2015) 23, 206e207
Available online at www.sciencedirect.com
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IMAGING FOR RESIDENTS
An Abnormal Blood Vessel in a Fetus at 22 Weeks of Gestation Fong-Ming Chang 1,2* 1 FMC e Fetal Medicine Center, Tai-Ang Clinic, and 2 Department of Obstetrics and Gynecology, National Cheng Kung University Medical College, Tainan, Taiwan
Section 2dAnswer A 30-year-old woman was referred to the Fetal Medicine Center of our institution for fetal echocardiography at 22 weeks of gestation. She had an uneventful medical and obstetrical history. Her family history was also not contributory. The fetus was a singleton, with appropriate size for gestation. The Level II fetal ultrasound examination yielded a normal result. Color Doppler echocardiography revealed an abnormal vessel at the three-vessel-trachea view. What is the diagnosis?
Interpretation Color Doppler in the three-vessel-trachea view revealed an abnormal blood vessel (Figure 1; red arrow), which was the aberrant right subclavian artery (ARSA). ARSA can be traced from the junction of the aortic arch and ductus arteriosus and coursed along the posterior side of the trachea and esophagus toward the right clavicle and the right arm. In addition, ARSA was confirmed to show arterial waveform by pulsed Doppler.
Discussion ARSA is the most common anomaly of the aortic arch, occurring in 0.5e1.4% of the general population. However, around 14e20% of ARSA was reported to be associated with
Conflicts of interest: None. * Correspondence to: Dr Fong-Ming Chang, FMC e Fetal Medicine Center, Tai-Ang Clinic, 18 See-Hua Street, Tainan, Taiwan. E-mail address: [email protected]. http://dx.doi.org/10.1016/j.jmu.2015.08.002 0929-6441
Figure 1 An abnormal blood vessel (small arrows) was illustrated at the three-vessel-trachea view by using color Doppler ultrasound. AO Z aorta; ARSA Z aberrant right subclavian artery; PA Z pulmonary artery; SVC Z superior vena cava.
trisomy 21 and other aneuploidies [1]. Therefore, fetal karyotyping should be undertaken. In addition, ARSA was frequently demonstrated to be associated with other cardiac malformation, especially conotruncal malformation. The combination of ARSA and a conotruncal malformation increases the risk of 22q11 microdeletion [2]. Thus, the array comparative genomic hybridization test is also suggested for ARSA. ARSA should be differentiated with the azygos vein [3]. Using pulsed Doppler, arterial waveforms were demonstrated in ARSA, whereas venous waveforms were shown in the azygos vein.
Abnormal Blood Vessel in a Fetus
References [1] Chaoui R, Heling KS, Sarioglu N, et al. Aberrant right subclavian artery as a new cardiac sign in second- and third-trimester fetuses with Down syndrome. Am J Obstet Gynecol 2005;192: 257e63.
207 [2] Chaoui R, Rake A, Heling KS. Aortic arch with four vessels: Aberrant right subclavian artery. Ultrasound Obstet Gynecol 2008;31:115e7. [3] Gardiner H, Chaoui R. The fetal three-vessel and tracheal view revisited. Semin Fetal Neonatal Med 2013;18:261e8.
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.jmu-online.com
IMAGING FOR RESIDENTS
An Abnormal Blood Vessel in a Fetus at 22 Weeks of Gestation Fong-Ming Chang 1,2* 1 FMC e Fetal Medicine Center, Tai-Ang Clinic, and 2 Department of Obstetrics and Gynecology, National Cheng Kung University Medical College, Tainan, Taiwan
Section 2dAnswer A 30-year-old woman was referred to the Fetal Medicine Center of our institution for fetal echocardiography at 22 weeks of gestation. She had an uneventful medical and obstetrical history. Her family history was also not contributory. The fetus was a singleton, with appropriate size for gestation. The Level II fetal ultrasound examination yielded a normal result. Color Doppler echocardiography revealed an abnormal vessel at the three-vessel-trachea view. What is the diagnosis?
Interpretation Color Doppler in the three-vessel-trachea view revealed an abnormal blood vessel (Figure 1; red arrow), which was the aberrant right subclavian artery (ARSA). ARSA can be traced from the junction of the aortic arch and ductus arteriosus and coursed along the posterior side of the trachea and esophagus toward the right clavicle and the right arm. In addition, ARSA was confirmed to show arterial waveform by pulsed Doppler.
Discussion ARSA is the most common anomaly of the aortic arch, occurring in 0.5e1.4% of the general population. However, around 14e20% of ARSA was reported to be associated with
Conflicts of interest: None. * Correspondence to: Dr Fong-Ming Chang, FMC e Fetal Medicine Center, Tai-Ang Clinic, 18 See-Hua Street, Tainan, Taiwan. E-mail address: [email protected]. http://dx.doi.org/10.1016/j.jmu.2015.08.002 0929-6441
Figure 1 An abnormal blood vessel (small arrows) was illustrated at the three-vessel-trachea view by using color Doppler ultrasound. AO Z aorta; ARSA Z aberrant right subclavian artery; PA Z pulmonary artery; SVC Z superior vena cava.
trisomy 21 and other aneuploidies [1]. Therefore, fetal karyotyping should be undertaken. In addition, ARSA was frequently demonstrated to be associated with other cardiac malformation, especially conotruncal malformation. The combination of ARSA and a conotruncal malformation increases the risk of 22q11 microdeletion [2]. Thus, the array comparative genomic hybridization test is also suggested for ARSA. ARSA should be differentiated with the azygos vein [3]. Using pulsed Doppler, arterial waveforms were demonstrated in ARSA, whereas venous waveforms were shown in the azygos vein.
Abnormal Blood Vessel in a Fetus
References [1] Chaoui R, Heling KS, Sarioglu N, et al. Aberrant right subclavian artery as a new cardiac sign in second- and third-trimester fetuses with Down syndrome. Am J Obstet Gynecol 2005;192: 257e63.
207 [2] Chaoui R, Rake A, Heling KS. Aortic arch with four vessels: Aberrant right subclavian artery. Ultrasound Obstet Gynecol 2008;31:115e7. [3] Gardiner H, Chaoui R. The fetal three-vessel and tracheal view revisited. Semin Fetal Neonatal Med 2013;18:261e8.