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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

Seroma formation after modified Blalock-Taussig shunt. ECG-triggered volumetric contrast-enhanced cardiac CT (AquilionONE, Toshiba medical systems) is acquired in a single heart beat during systole at a heart rate of 127 beats per minute. Transverse orientation ((a)–(e)) and coronal orientation (f). 3 years old female patient after repair of pulmonary atresia by unifocalization and bilateral modified Blalock-Taussig shunt (BT). Extensive mediastinal fluid (F, all images) in the upper part of mediastinum. Note the excellent image quality showing the left BT shunt (L-BT, (a)) and right-BT shunt (R-BT, (b)), right coronary artery (RCA, (c)), left coronary artery (LCA, (d)), major aorta to pulmonary collateral arteries (MAPCA in c, (d)), and large subaortic ventricular septum defect (black arrow, (e)). The superior vena cava was severely compressed by the mediastinal fluid collection (white arrow, (f)). Ao: aorta; LV: left ventricle; RV: right ventricle. Dose-length product of the CT scan was 20.9 mGy·cm. Correction factor for chest CT at 100 kV for 3 years age was 0.039 mSv·mGy−1·cm−1; effective dose E was 0.8 mSv.
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fig3: Seroma formation after modified Blalock-Taussig shunt. ECG-triggered volumetric contrast-enhanced cardiac CT (AquilionONE, Toshiba medical systems) is acquired in a single heart beat during systole at a heart rate of 127 beats per minute. Transverse orientation ((a)–(e)) and coronal orientation (f). 3 years old female patient after repair of pulmonary atresia by unifocalization and bilateral modified Blalock-Taussig shunt (BT). Extensive mediastinal fluid (F, all images) in the upper part of mediastinum. Note the excellent image quality showing the left BT shunt (L-BT, (a)) and right-BT shunt (R-BT, (b)), right coronary artery (RCA, (c)), left coronary artery (LCA, (d)), major aorta to pulmonary collateral arteries (MAPCA in c, (d)), and large subaortic ventricular septum defect (black arrow, (e)). The superior vena cava was severely compressed by the mediastinal fluid collection (white arrow, (f)). Ao: aorta; LV: left ventricle; RV: right ventricle. Dose-length product of the CT scan was 20.9 mGy·cm. Correction factor for chest CT at 100 kV for 3 years age was 0.039 mSv·mGy−1·cm−1; effective dose E was 0.8 mSv.

Mentions: A three-year-old girl was admitted to the hospital because of suspected mediastinal fluid that was observed during routine echocardiography. The patient was known with pulmonary atresia with major aorta to pulmonary collateral arteries. Unifoclization with the use of a modified Blalock Taussig shunt on the left side was performed at the age of 1 month and on the right side at 7 months of age. Replacement of bilateral modified Blalock-Taussig shunts was done 1 month before admittance. CT imaging was performed to assess the nature and extent of the mediastinal fluid. Extensive mediastinal fluid collection, without any signs of mediastinitis, was found; it severely compressed the superior caval vein. All relevant anatomic structures and surgical shunts were evaluated (Figure 3). The mediastinal fluid collection was punctured and percutaneously drained. Analysis of the fluid revealed seroma, leading to the final diagnosis of perigraft seroma formation around the modified Blalock Taussig shunt.


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)

Seroma formation after modified Blalock-Taussig shunt. ECG-triggered volumetric contrast-enhanced cardiac CT (AquilionONE, Toshiba medical systems) is acquired in a single heart beat during systole at a heart rate of 127 beats per minute. Transverse orientation ((a)–(e)) and coronal orientation (f). 3 years old female patient after repair of pulmonary atresia by unifocalization and bilateral modified Blalock-Taussig shunt (BT). Extensive mediastinal fluid (F, all images) in the upper part of mediastinum. Note the excellent image quality showing the left BT shunt (L-BT, (a)) and right-BT shunt (R-BT, (b)), right coronary artery (RCA, (c)), left coronary artery (LCA, (d)), major aorta to pulmonary collateral arteries (MAPCA in c, (d)), and large subaortic ventricular septum defect (black arrow, (e)). The superior vena cava was severely compressed by the mediastinal fluid collection (white arrow, (f)). Ao: aorta; LV: left ventricle; RV: right ventricle. Dose-length product of the CT scan was 20.9 mGy·cm. Correction factor for chest CT at 100 kV for 3 years age was 0.039 mSv·mGy−1·cm−1; effective dose E was 0.8 mSv.
© Copyright Policy - open-access
Related In: Results  -  Collection

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fig3: Seroma formation after modified Blalock-Taussig shunt. ECG-triggered volumetric contrast-enhanced cardiac CT (AquilionONE, Toshiba medical systems) is acquired in a single heart beat during systole at a heart rate of 127 beats per minute. Transverse orientation ((a)–(e)) and coronal orientation (f). 3 years old female patient after repair of pulmonary atresia by unifocalization and bilateral modified Blalock-Taussig shunt (BT). Extensive mediastinal fluid (F, all images) in the upper part of mediastinum. Note the excellent image quality showing the left BT shunt (L-BT, (a)) and right-BT shunt (R-BT, (b)), right coronary artery (RCA, (c)), left coronary artery (LCA, (d)), major aorta to pulmonary collateral arteries (MAPCA in c, (d)), and large subaortic ventricular septum defect (black arrow, (e)). The superior vena cava was severely compressed by the mediastinal fluid collection (white arrow, (f)). Ao: aorta; LV: left ventricle; RV: right ventricle. Dose-length product of the CT scan was 20.9 mGy·cm. Correction factor for chest CT at 100 kV for 3 years age was 0.039 mSv·mGy−1·cm−1; effective dose E was 0.8 mSv.
Mentions: A three-year-old girl was admitted to the hospital because of suspected mediastinal fluid that was observed during routine echocardiography. The patient was known with pulmonary atresia with major aorta to pulmonary collateral arteries. Unifoclization with the use of a modified Blalock Taussig shunt on the left side was performed at the age of 1 month and on the right side at 7 months of age. Replacement of bilateral modified Blalock-Taussig shunts was done 1 month before admittance. CT imaging was performed to assess the nature and extent of the mediastinal fluid. Extensive mediastinal fluid collection, without any signs of mediastinitis, was found; it severely compressed the superior caval vein. All relevant anatomic structures and surgical shunts were evaluated (Figure 3). The mediastinal fluid collection was punctured and percutaneously drained. Analysis of the fluid revealed seroma, leading to the final diagnosis of perigraft seroma formation around the modified Blalock Taussig shunt.

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