Case of the Week #559
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.
![](/site/cache/public/images/01.png/01.png-4/fieldList/file_path/79513__600__451__down__95.png)
![](/site/cache/public/images/02a.pn/02a.png-1/fieldList/file_path/79514__600__451__down__95.png)
![](/site/cache/public/images/03a.pn/03a.png/fieldList/file_path/79515__600__451__down__95.png)
![](/site/cache/public/images/04a.pn/04a.png-1/fieldList/file_path/79516__600__451__down__95.png)
![](/site/cache/public/images/05a.pn/05a.png-2/fieldList/file_path/79517__600__451__down__95.png)
![](/site/cache/public/images/06a.pn/06a.png-1/fieldList/file_path/79518__600__451__down__95.png)
![](/site/cache/public/images/07a.pn/07a.png/fieldList/file_path/79519__600__451__down__95.png)
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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].
![Four-chamber-view of the heart](/site/cache/public/images/01.png/01.png-5/fieldList/file_path/65865__600__451__down__95.png)
![Transverse scan of the thorax at the level of the aortic arch. Ao - aorta; SVC - Superior Vena Cava](/site/cache/public/images/02b.pn/02b.png-1/fieldList/file_path/65866__600__451__down__95.png)
![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)](/site/cache/public/images/03b.pn/03b.png/fieldList/file_path/65867__600__451__down__95.png)
![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)](/site/cache/public/images/04b.pn/04b.png-1/fieldList/file_path/65868__600__451__down__95.png)
![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)](/site/cache/public/images/05b.pn/05b.png-1/fieldList/file_path/65869__600__451__down__95.png)
![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).](/site/cache/public/images/06b.pn/06b.png-1/fieldList/file_path/65870__600__451__down__95.png)
![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.](/site/cache/public/images/cross-/cross-ribbon-sign-laa-and-rda.png/fieldList/file_path/65871__960__850__down__95.png)
![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.](/site/cache/public/images/cross-/cross-ribbon-sign-laa-and-rda-2.png/fieldList/file_path/65872__960__850__down__95.png)
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
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