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Patent ductus arteriosus
Etiology: failure of closure of the fetal ductus arteriosus leading to a left to right shunt
CXR: cardiomegaly and increased pulmonary blood flow that increases over time
Angiogram: simultaneous filling of the pulmonary artery and aorta when either is injected
Imaging: 33% have a ductus diverticulum which is a developmental outpouching aortic isthmus where ductus arteriosus attaches which also happens to be the site of 90% of post-traumatic aortic injuries so it should not be mistaken for a traumatic aortic pseudoaneurysm
Complications: prostaglandin E – keeps patent ductus arteriosus open in patent ductus arteriosus dependent congenital heart diseases (pulmonary atresia, hypoplastic left heart syndrome), can cause cortical hyperostosis, can cause gastric mucosal hypertrophy mimicing hypertrophic pyloric stenosis
Complications: indomethacin – closes patent ductus arteriosus, can cause gastrointestinal perforation
Clinical: acyanotic
Cases of Patent Ductus Arteriosus
CXR AP at 1 day of life (above) and 1 year of life (below) shows interval development of cardiomegaly and pulmonary vascular congestion.CXR AP shows mild cardiomegaly and pulmonary vascular congestion along with an extra soft tissue mass just to the left of the spine near the presumed position of the ductus arteriosus.AP angiogram while injecting the pulmonary artery shows simultaneous filling of the descending aorta.AP image from a ventricular injection in an angiogram shows simultaneous opacification of the aorta and main pulmonary artery.