PMC3569889_01
Mediastinitis after Contegra conduit and late complication of large mediastinal fluid collection. ECG-triggered volumetric contrast-enhanced cardiac CT (AquilionONE, Toshiba medical systems, Otawara, Japan) is acquired at end systole (45% of cardiac RR cycle). Transverse views in 8-year male patient with moderate soft tissue/fluid collection around ascending aorta (Ao, in (a)). Relative stenosis of Contegra conduit (arrow, (a)). Patient also had osteolytic destruction of parts of sternum compatible with osteomyelitis (not shown). Diagnosis mediastinitis was based on CT findings and clinical findings. Ventricles at lower level (b). Nine months later; large mediastinal fluid collection and subtotal compression on the Contegra conduit (arrow, (c)). Note the secondary massive right ventricle (RV) dilatation due to outflow obstruction (d). Ao: aorta; LV: left ventricle; RPA: right pulmonary artery. Dose-length products of the CT scans were 26.4 mGy cm for the first scan (a, b) and 29.5 mGy cm for the second scan (c, d). Correction factor for chest CT at 100 kV for 8 years age was 0.026 mSv mGy-1 cm-1; effective doses E were 0.7 mSv and 0.8 mSv, respectively.
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fig1
With CT, diagnosis of mediastinitis was made with moderate compression of Contegra conduit (Figures 1(a) and 1(b)). CT imaging showed large amount of mediastinal fluid with severe narrowing of the Contegra conduit, and massive right ventricular dilatation due to outflow obstruction by subtotal conduit obstruction (Figures 1(c) and 1(d)).
Active blood extravasation due to suture leakage. Same patient as in Figure 1 showing active extravasation of contrast (which is leakage of blood, arrows in (a) and (b)) ventral to the aorta (Ao) caused by suture leakage during chronic mediastinitis. Note accumulation of blood during delayed imaging (arrows, (b)). F: mediastinal fluid; PF: pleural fluid. Effective dose E = 0.8 mSv.
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fig2
The mediastinal fluid collection was diagnosed as being active extravasation caused by suture leakage, most likely due to chronic mediastinitis (Figure 2).
PMC3569889_02
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
All relevant anatomic structures and surgical shunts were evaluated (Figure 3).
PMC3569889_03
Pseudoaneurysm after surgical repair. ECG-triggered volumetric contrast-enhanced cardiac CT (AquilionONE, Toshiba medical systems) acquired during systole within a single heart beat at a heart rate of 109 beats per minute, in 2 years female patient. Image in transverse orientation. Large precardiac contrast collection (CC) with open connection (two-sided arrow) to the right ventricle (RV), at the site of RV patch (P). CT differential diagnosis was RV patch aneurysm or pseudoaneurysm. Surgery confirmed pseudoaneurysm. Dose-length product of the CT scan was 18.2 mGy cm. Correction factor for chest CT at 100 kV for 2 years age was 0.044 mSv mGy-1 cm-1; effective dose E was 1.4 mSv.
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fig4
CT, a large precardiac fluid collection with open connection to the right ventricle was found (Figure 4). CT differential diagnosis was right ventricular patch aneurysm or pseudoaneurysm.