We present a case of Tortuous Ductus Arteriosus (also called Ductal aneurysm).

Ultrasound images show the following:

• Image 1: Grayscale image of a tortuous Ductus Arteriosus
• Image 2: Change in flow direction and increased velocity (aliasing) demonstrated by color Doppler
• Image 3: 3-vessel-tracheal view demonstrating a tortuous Ductus Arteriosus and a persistent Left Superior Vena Cava (LSVC).

Discussion

The Ductus Arteriosus is a blood vessel segment that connects the main pulmonary trunk to the proximal descending aorta. It plays a vital role in fetal circulation as it allows the majority of the deoxygenated blood coming from the right ventricle to bypass the fetal lungs and join the thoracic aorta. Half of the blood flowing through the thoracic aorta returns to the placenta via the umbilical arteries where oxygenation occurs.

A tortuous Ductus Arteriosus, with an S-configuration, toward the end of gestation (late third trimester) is considered a normal finding with no clinical implications, as Ductus Arteriosus aneurysms resolve spontaneously in postnatal life. Nonetheless, a small group of infants develop complications such as thrombo-embolism, and compression of nearby thoracic structures. Postnatal evaluation is therefore recommended in this group.

References

[1] Abuhamad, A.Z., Chaoui, R. (2016). A practical guide to fetal echocardiography: Normal and abnormal hearts (3rd ed.). Philadelphia, PA: Wolters Kluwer.
[2] Ganesan, S., Hutchinson, D.P., Sampson, A.J. (2015). Prenatal diagnosis of ductus arteriosus aneurysm. Ultrasound, 23(4), 251-253.