Case of the Week #559

Azar Farajov
Azerbaijan

Posting Dates: May 15 - May 30, 2022

Case Report: 28-year-old woman (G3P2), with non-contributive history, presented to our office at 19 weeks + 3 days of her pregnancy. Following images and videos show an interesting cardiac anomaly that we found during our examination.

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Answer

Current COW represented a case of left aortic arch and right ductus arteriosus making so called "cross ribbon sign" [1].

**Image 1** Four-chamber-view of the heart

**Image 2** Transverse scan of the thorax at the level of the aortic arch. Ao - aorta; SVC - Superior Vena Cava

**Image 3** Three-vessel-trachea view of the heart showing pulmonary artery (PA), ascending aorta (Ao), superior vena cava (SVC), descending aorta (DAo), right pulmonary artery (RPA)

**Image 4** Three-vessel-trachea view of the heart showing pulmonary artery (PA), RIGHT DUCTUS ARTERIOSUS (RDA), ascending aorta (Ao), superior vena cava (SVC), descending aorta (DAo)

**Image 5** Three-vessel-trachea view of the heart showing pulmonary artery (PA), RIGHT DUCTUS ARTERIOSUS (RDA) making a vascular sling around trachea and connecting to the descending aorta (DAo), ascending aorta (Ao), superior vena cava (SVC)

**Image 6** Color Doppler: three-vessel-trachea view - pulmonary artery (PA), RIGHT DUCTUS ARTERIOSUS (RDA) making a vascular ring around trachea and connecting to the descending aorta (DAo). Ascending aorta (Ao), superior vena cava (SVC).

**Image 7** Drawing of the "cross ribbon sign" type of vascular ring. Right ductus arteriosus (RDA), left aortic arch (LAA). LPA - left pulmonary artery, RPA - right pulmonary artery, DA - descending aorta.

References:

1. Vijayaraghavan SB, Senthil S, Latha K. Prenatal diagnosis of a rare aortic arch anomaly with left aortic arch and right ductus arteriosus: Cross ribbon sign. Indian J Radiol Imaging. 2017;27(1):70-72. doi:10.4103/0971-3026.202963