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Volumetric Computed Tomography Angiography in the Evaluation of Mediastinal Fluid Collections following Congenital Cardiac Surgery.

Roest AA, Roelofs J, Hazekamp MG, Rijlaarsdam ME, Geleijns J, Kroft LJ - Case Rep Pediatr (2013)

Bottom Line: We present 3 patients with 4 causes of mediastinal fluid collection after congenital cardiac surgery in this extended case report.Volumetric computed tomography played an essential role in diagnosing causes and extent, relevant to subsequent management.Recent advances in volumetric computed tomography allow fast and accurate imaging of cardiovascular and extravascular structures in children with acceptable radiation dose, providing a powerful imaging tool for the evaluation of complications after congenital cardiac surgery.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatric Cardiology, Leiden University Medical Center, Albinusdreef 2, P.O. Box 9600, 2300 RC Leiden, The Netherlands.

ABSTRACT
We present 3 patients with 4 causes of mediastinal fluid collection after congenital cardiac surgery in this extended case report. Volumetric computed tomography played an essential role in diagnosing causes and extent, relevant to subsequent management. Recent advances in volumetric computed tomography allow fast and accurate imaging of cardiovascular and extravascular structures in children with acceptable radiation dose, providing a powerful imaging tool for the evaluation of complications after congenital cardiac surgery.

No MeSH data available.


Related in: MedlinePlus

Mediastinitis after Contegra conduit and late complication of large mediastinal fluid collection. ECG-triggered volumetric contrast-enhanced cardiac CT (AquilionONE, Toshiba medical systems, Otawara, Japan) is acquired at end systole (45% of cardiac RR cycle). Transverse views in 8-year male patient with moderate soft tissue/fluid collection around ascending aorta (Ao, in (a)). Relative stenosis of Contegra conduit (arrow, (a)). Patient also had osteolytic destruction of parts of sternum compatible with osteomyelitis (not shown). Diagnosis mediastinitis was based on CT findings and clinical findings. Ventricles at lower level (b). Nine months later; large mediastinal fluid collection and subtotal compression on the Contegra conduit (arrow, (c)). Note the secondary massive right ventricle (RV) dilatation due to outflow obstruction (d). Ao: aorta; LV: left ventricle; RPA: right pulmonary artery. Dose-length products of the CT scans were 26.4 mGy·cm for the first scan (a, b) and 29.5 mGy·cm for the second scan (c, d). Correction factor for chest CT at 100 kV for 8 years age was 0.026 mSv·mGy−1·cm−1; effective doses E were 0.7 mSv and 0.8 mSv, respectively.
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fig1: Mediastinitis after Contegra conduit and late complication of large mediastinal fluid collection. ECG-triggered volumetric contrast-enhanced cardiac CT (AquilionONE, Toshiba medical systems, Otawara, Japan) is acquired at end systole (45% of cardiac RR cycle). Transverse views in 8-year male patient with moderate soft tissue/fluid collection around ascending aorta (Ao, in (a)). Relative stenosis of Contegra conduit (arrow, (a)). Patient also had osteolytic destruction of parts of sternum compatible with osteomyelitis (not shown). Diagnosis mediastinitis was based on CT findings and clinical findings. Ventricles at lower level (b). Nine months later; large mediastinal fluid collection and subtotal compression on the Contegra conduit (arrow, (c)). Note the secondary massive right ventricle (RV) dilatation due to outflow obstruction (d). Ao: aorta; LV: left ventricle; RPA: right pulmonary artery. Dose-length products of the CT scans were 26.4 mGy·cm for the first scan (a, b) and 29.5 mGy·cm for the second scan (c, d). Correction factor for chest CT at 100 kV for 8 years age was 0.026 mSv·mGy−1·cm−1; effective doses E were 0.7 mSv and 0.8 mSv, respectively.

Mentions: An 8 years and 2 months old male patient presented with increasing presternal swelling and mildly increased CRP of 31 mg/L. The patient had a history of truncus arteriosus (TA) with 22q11 deletion. The TA was corrected at the age of 2 weeks; the truncal valve was replaced by a bileaflet mechanical valve at the age of 1 year. At the age of 8 years, the right ventricular to pulmonary artery conduit was replaced by valve-containing Contegra conduit and, aortic valve replacement was done with a mechanical valve. Four months prior to admittance a pacemaker was placed because of complete atrioventricular block. The week before admittance, the parents noted a swelling at the sternotomy scar, which increased during the week, and was suspected for an infectious process or hematoma. Computed tomography (CT) imaging was performed for further evaluation. With CT, diagnosis of mediastinitis was made with moderate compression of Contegra conduit (Figures 1(a) and 1(b)). The next day the mediastinum was surgically explored, confirming extensive mediastinitis. Purulent effusion was removed, and omentum plasty was performed with application of gentamicin pearls. The patient was treated with intravenous antibiotics for an extensive period. Nine months later, the patient was admitted to the intensive care unit because of low blood pressure and seizures. CT imaging showed large amount of mediastinal fluid with severe narrowing of the Contegra conduit, and massive right ventricular dilatation due to outflow obstruction by subtotal conduit obstruction (Figures 1(c) and 1(d)). The mediastinal fluid collection was diagnosed as being active extravasation caused by suture leakage, most likely due to chronic mediastinitis (Figure 2). Surgical relieve was performed and sutures were placed on the proximal anastomosis of the vascular prosthesis.


Volumetric Computed Tomography Angiography in the Evaluation of Mediastinal Fluid Collections following Congenital Cardiac Surgery.

Roest AA, Roelofs J, Hazekamp MG, Rijlaarsdam ME, Geleijns J, Kroft LJ - Case Rep Pediatr (2013)

Mediastinitis after Contegra conduit and late complication of large mediastinal fluid collection. ECG-triggered volumetric contrast-enhanced cardiac CT (AquilionONE, Toshiba medical systems, Otawara, Japan) is acquired at end systole (45% of cardiac RR cycle). Transverse views in 8-year male patient with moderate soft tissue/fluid collection around ascending aorta (Ao, in (a)). Relative stenosis of Contegra conduit (arrow, (a)). Patient also had osteolytic destruction of parts of sternum compatible with osteomyelitis (not shown). Diagnosis mediastinitis was based on CT findings and clinical findings. Ventricles at lower level (b). Nine months later; large mediastinal fluid collection and subtotal compression on the Contegra conduit (arrow, (c)). Note the secondary massive right ventricle (RV) dilatation due to outflow obstruction (d). Ao: aorta; LV: left ventricle; RPA: right pulmonary artery. Dose-length products of the CT scans were 26.4 mGy·cm for the first scan (a, b) and 29.5 mGy·cm for the second scan (c, d). Correction factor for chest CT at 100 kV for 8 years age was 0.026 mSv·mGy−1·cm−1; effective doses E were 0.7 mSv and 0.8 mSv, respectively.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3569889&req=5

fig1: Mediastinitis after Contegra conduit and late complication of large mediastinal fluid collection. ECG-triggered volumetric contrast-enhanced cardiac CT (AquilionONE, Toshiba medical systems, Otawara, Japan) is acquired at end systole (45% of cardiac RR cycle). Transverse views in 8-year male patient with moderate soft tissue/fluid collection around ascending aorta (Ao, in (a)). Relative stenosis of Contegra conduit (arrow, (a)). Patient also had osteolytic destruction of parts of sternum compatible with osteomyelitis (not shown). Diagnosis mediastinitis was based on CT findings and clinical findings. Ventricles at lower level (b). Nine months later; large mediastinal fluid collection and subtotal compression on the Contegra conduit (arrow, (c)). Note the secondary massive right ventricle (RV) dilatation due to outflow obstruction (d). Ao: aorta; LV: left ventricle; RPA: right pulmonary artery. Dose-length products of the CT scans were 26.4 mGy·cm for the first scan (a, b) and 29.5 mGy·cm for the second scan (c, d). Correction factor for chest CT at 100 kV for 8 years age was 0.026 mSv·mGy−1·cm−1; effective doses E were 0.7 mSv and 0.8 mSv, respectively.
Mentions: An 8 years and 2 months old male patient presented with increasing presternal swelling and mildly increased CRP of 31 mg/L. The patient had a history of truncus arteriosus (TA) with 22q11 deletion. The TA was corrected at the age of 2 weeks; the truncal valve was replaced by a bileaflet mechanical valve at the age of 1 year. At the age of 8 years, the right ventricular to pulmonary artery conduit was replaced by valve-containing Contegra conduit and, aortic valve replacement was done with a mechanical valve. Four months prior to admittance a pacemaker was placed because of complete atrioventricular block. The week before admittance, the parents noted a swelling at the sternotomy scar, which increased during the week, and was suspected for an infectious process or hematoma. Computed tomography (CT) imaging was performed for further evaluation. With CT, diagnosis of mediastinitis was made with moderate compression of Contegra conduit (Figures 1(a) and 1(b)). The next day the mediastinum was surgically explored, confirming extensive mediastinitis. Purulent effusion was removed, and omentum plasty was performed with application of gentamicin pearls. The patient was treated with intravenous antibiotics for an extensive period. Nine months later, the patient was admitted to the intensive care unit because of low blood pressure and seizures. CT imaging showed large amount of mediastinal fluid with severe narrowing of the Contegra conduit, and massive right ventricular dilatation due to outflow obstruction by subtotal conduit obstruction (Figures 1(c) and 1(d)). The mediastinal fluid collection was diagnosed as being active extravasation caused by suture leakage, most likely due to chronic mediastinitis (Figure 2). Surgical relieve was performed and sutures were placed on the proximal anastomosis of the vascular prosthesis.

Bottom Line: We present 3 patients with 4 causes of mediastinal fluid collection after congenital cardiac surgery in this extended case report.Volumetric computed tomography played an essential role in diagnosing causes and extent, relevant to subsequent management.Recent advances in volumetric computed tomography allow fast and accurate imaging of cardiovascular and extravascular structures in children with acceptable radiation dose, providing a powerful imaging tool for the evaluation of complications after congenital cardiac surgery.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatric Cardiology, Leiden University Medical Center, Albinusdreef 2, P.O. Box 9600, 2300 RC Leiden, The Netherlands.

ABSTRACT
We present 3 patients with 4 causes of mediastinal fluid collection after congenital cardiac surgery in this extended case report. Volumetric computed tomography played an essential role in diagnosing causes and extent, relevant to subsequent management. Recent advances in volumetric computed tomography allow fast and accurate imaging of cardiovascular and extravascular structures in children with acceptable radiation dose, providing a powerful imaging tool for the evaluation of complications after congenital cardiac surgery.

No MeSH data available.


Related in: MedlinePlus