Presentation
History of prematurity, poor feeding and bronchopulmonary dysplasia
Patient Data
1. The nasogastric tube terminates in the mid gastric body in good position. The mediastinal PDA clip is in appropriate position.
2. No discrete focal pneumonia, effusion or pneumothorax. Mild bilateral peribronchial thickening may be due to aspiration and/or reactive airway disease/viral process.
3. Minimal scattered fibroatelectasis in this 5-month-old with history of extreme prematurity and bronchopulmonary dysplasia.
4. The cardiothymic silhouette is mildly diffusely prominent with an elevated cardiac apex and may be due to right ventricular hypertrophy.
5. No acute osseous findings. Aerophagic bowel gas pattern is noted in the visualized upper abdomen.
Case Discussion
The ductus arteriosus branches from the posterior arch of the aorta and inserts into the anterior pulmonary artery. Patent dutus arteriosus (PDA) refers to the nonclosure of the ductus arteriosus which circulates oxygenated blood by avoiding the pulmonary circulation in utero. Normal development allows the ductus arteriosus to be functionally closed by 12-24 hours of life and permanently closed in 2-3 weeks old for full-term newborns.
Initial management of PDA aims to inhibit the production of prostaglandins with pharamcologic treatment such as indomethacin, ibuprofen, or acetaminophen along with conservative measures such as fluid restriction and supportive care. If it is not closed with medical management, surgical treatment is indicated by either direct closure or percutaneous ligation with a clip of a tie. Recently, PDA closure device has also been used to avoid open surgery in newborn babies.
This case was submitted with supervision and input from:
Soni C. Chawla, M.D.
Health Sciences Clinical Professor,
Department of Radiological Sciences,
David Geffen School of Medicine at UCLA.
Attending Pediatric Radiologist,
Olive View - UCLA Medical Center.
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