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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Video 1 ©2022 Azer Farajov
Video 2 ©2022 Azer Farajov
Video 3 ©2022 Azer Farajov

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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
Image 1 Four-chamber-view of the heart
Transverse scan of the thorax at the level of the aortic arch. Ao - aorta; SVC - Superior Vena Cava
Image 2 Transverse scan of the thorax at the level of the aortic arch. Ao - aorta; SVC - Superior Vena Cava
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 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)
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 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)
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 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)
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 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).
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.
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.
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.
Image 8 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

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