PMC8964601_01
Frontal chest radiograph (A) shows the tip of the umbilical arterial catheter (UAC) at the level of T8 vertebral body with curved configuration of its terminal portion (black arrowheads). Several rib and left clavicular fractures (black arrows) are also noted in the bony thoracic cage. Chest CT Angiography coronal multi-planar reconstruction image at the level of thoraco-abdominal aorta (B) and 3D surface shaded display image of the thoraco-abdominal aorta (C) showing the arterial tortuosity with distal end of the UAC location in descending thoracic aorta.
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The umbilical artery catheter (UAC) (Figure 1) was incidentally noted to have a tortuous course on radiograph on D5 of life (Figure 2A).
Chest CT Angiography 3D surface shaded display images: Anterior view of the thoraco-abdominal aorta (A); Posterior view of the combined thoraco-abdominal aorta and pulmonary arteries (B); Antero-superior view of the subtracted pulmonary arterial circulation and right atrium (C); Superior view of the subtracted pulmonary venous circulation and left atrium (D). Oblique coronal gray-scale (E); and color Doppler (F,G) echocardiography images of the aortic arch and its major branches. The left-sided aortic arch has an unusual configuration with the dilated innominate artery forming a hairpin turn before its bifurcation into right subclavian and common carotid arteries (arrowheads in A,B). The left common carotid and subclavian arteries arise from the hypoplastic mid arch (arrows in A,B). The thoraco-abdominal aorta is tortuous. Included abdominal aorta shows dilated and tortuous branches of the coeliac axis. The main pulmonary artery is short with early bifurcation with long tubular configuration and parallel proximal course of the right and left main pulmonary arteries (arrowheads in C). Normal morphology of bilateral pulmonary veins draining into the left atrium (D). Some of these findings are also demonstrated on echocardiography images (arrows in E-G).
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He was also noted to have multiple fractures involving ribs and left clavicle (Figure 2), and a comminuted right parietal skull fracture. The superior "arch" coursed leftward, with the right common carotid and subclavian arteries arising from it, while the hypoplastic arch coursed inferiorly giving rise to the left common carotid and subclavian arteries (Figures 2E-G). The umbilical artery catheter (UAC) (Figure 1) was incidentally noted to have a tortuous course on radiograph on D5 of life (Figure 2A). Tomography Aortogram (CTA) was performed to evaluate the aortic arch anatomy. CTA confirmed the findings of a left-sided aortic arch with a dilated and tortuous right brachiocephalic artery forming a hairpin loop before bifurcating into the right subclavian and common carotid arteries (Figures 2B,C). The branch pulmonary arteries appeared unusual as well, with proximal segments coursing parallel to each other before branching to the left and right, respectively (Figures 2A-C). The pulmonary veins were normal (Figure 2D).
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