Book contents
- Frontmatter
- Contents
- List of contributors
- Preface
- Acknowledgment
- Section 1 Head and neck
- Section 2 Thoracic imaging
- Section 3 Cardiac imaging
- Case 23 Tetralogy of Fallot with pulmonary atresia
- Case 24 Left pulmonary artery sling
- Case 25 Vascular ring
- Case 26 Scimitar syndrome
- Case 27 Portosystemic shunt and portopulmonary syndrome
- Case 28 Aortic coarctation and interrupted aortic arch
- Case 29 Ebstein’s anomaly
- Case 30 Transposition of the great arteries
- Case 31 Total anomalous pulmonary venous return
- Case 32 Aberrant left coronary artery arising from the pulmonary artery
- Section 4 Vascular and interventional
- Section 5 Gastrointestinal imaging
- Section 6 Urinary imaging
- Section 7 Endocrine - reproductive imaging
- Section 8 Fetal imaging
- Section 9 Musculoskeletal imaging
- Index
- References
Case 32 - Aberrant left coronary artery arising from the pulmonary artery
from Section 3 - Cardiac imaging
Published online by Cambridge University Press: 05 June 2014
- Frontmatter
- Contents
- List of contributors
- Preface
- Acknowledgment
- Section 1 Head and neck
- Section 2 Thoracic imaging
- Section 3 Cardiac imaging
- Case 23 Tetralogy of Fallot with pulmonary atresia
- Case 24 Left pulmonary artery sling
- Case 25 Vascular ring
- Case 26 Scimitar syndrome
- Case 27 Portosystemic shunt and portopulmonary syndrome
- Case 28 Aortic coarctation and interrupted aortic arch
- Case 29 Ebstein’s anomaly
- Case 30 Transposition of the great arteries
- Case 31 Total anomalous pulmonary venous return
- Case 32 Aberrant left coronary artery arising from the pulmonary artery
- Section 4 Vascular and interventional
- Section 5 Gastrointestinal imaging
- Section 6 Urinary imaging
- Section 7 Endocrine - reproductive imaging
- Section 8 Fetal imaging
- Section 9 Musculoskeletal imaging
- Index
- References
Summary
Imaging description
A five-month-old female infant presented with persistent tachypnea and failure to thrive. Frontal and lateral chest radiographs (Fig. 32.1a, b) demonstrated marked cardiomegaly, hyperinflation, and pulmonary venous congestion consistent with cardiogenic pulmonary edema. An echocardiogram was obtained that demonstrated marked left ventricular dilatation with very poor contractility (Fig. 32.1c). No additional abnormality was found. Of note, the coronary origins were thought to be normal on Doppler ultrasound (US), with normal direction of flow (Fig. 32.1d). Additional history, clinical examination, and laboratory investigation failed to reveal an underlying cause for the cardiac dysfunction. A gated CT angiogram was obtained, primarily to confirm that the coronary arteries were indeed normal. The CTA, timed for optimal contrast in the aorta and coronary arteries, demonstrated a single right coronary artery arising from the densely contrast-filled aorta (Fig. 32.1e). The left coronary artery was shown to arise anomalously from the posterior aspect of the pulmonary artery (Fig. 32.1f, g). The relative lack of contrast opacification of the left coronary artery and its branches, similar to the pulmonary artery, confirmed the antegrade flow pattern seen on Doppler. It was hypothesized that chronic hypoxia and pulmonary hypertension resulted in this atypical flow pattern for aberrant left coronary artery arising from the pulmonary artery (ALCAPA). Furthermore, it appeared that the rightward and posterior course of the left circumflex branch close to the aorta produced the appearance mistaken on US for a normal aortic origin of the left coronary artery.
- Type
- Chapter
- Information
- Pearls and Pitfalls in Pediatric ImagingVariants and Other Difficult Diagnoses, pp. 141 - 146Publisher: Cambridge University PressPrint publication year: 2014