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Developmental abnormalities of the great vessels of the thorax and their embryological basis

Department of Radiology, The Queen Elizabeth Hospital, Edgbaston, Birmingham B15 2TH, UK

View larger version (51K): [in a new window]   Figure 1. Diagrams showing transformation of the early aortic arch pattern (6–8 weeks) into the adult pattern. Reproduced with permission, Moore KL. The developing human: clinically orientated embryology. WB Saunders Company, 1982.

View larger version (39K): [in a new window]   Figure 2. Diagram showing the embryological basis of a double aortic arch. Reproduced with permission, Moore KL. The developing human: clinically orientated embryology. WB Saunders Company, 1982.

View larger version (42K): [in a new window]   Figure 3. Sequential images (a,b) of a contrast-enhanced spiral CT angiogram of a double aortic arch.

View larger version (102K): [in a new window]   Figure 4. Detail of (a) chest radiograph and (b) axial MR image in a patient with a right-sided aortic arch. Note the right paratracheal "mass" (arrows) with tracheal displacement to the left in (a) and superior vena cava (SVC) (large arrow) and trachea (small arrow) in (b). A central venous catheter is present in the SVC in (a).

View larger version (39K): [in a new window]   Figure 5. Diagram showing the embryological basis of a right-sided aortic arch without a retro-oesophageal component. Reproduced with permission, Moore KL. The developing human: clinically orientated embryology. WB Saunders Company, 1982.

View larger version (100K): [in a new window]   Figure 6. Intravenous digitally subtracted angiogram (a), with corresponding line diagram (b), demonstrating a large aneurysm arising from a cervical aortic arch. Note that the cervical arch (large arrow) extends above the clavicle (small arrows). The common carotid arteries are indicated with arrow heads.

View larger version (21K): [in a new window]   Figure 7. Diagram showing the embryological basis of an aberrant right subclavian artery. Reproduced with permission, Moore KL. The developing human: clinically orientated embryology. WB Saunders Company, 1982.

View larger version (89K): [in a new window]   Figure 8. (a) Barium swallow and (b) contrast enhanced CT image in a patient with an aneurysm arising from an aberrant right subclavian artery. Note the posterior vascular impression on the oesophagus in (a).

View larger version (113K): [in a new window]   Figure 9. (a) Diagrammatic explanation of the embryological basis for aortic coarctation. Reproduced with permission, Moore KL. The developing human: clinically orientated embryology. WB Saunders Company, 1982. (b) Parasagittal cine MRI showing an aortic coarctation (arrow). (c) Detail of a chest radiograph showing left-sided inferior rib notching (arrows) due to collateral circulation in a patient with post-ductal aortic coarctation.

View larger version (146K): [in a new window]   Figure 10. Arch aortogram showing a patent ductus arteriosus (arrow). (Courtesy of Dr S Darby.)

View larger version (140K): [in a new window]   Figure 11. Posterior view of a perfusion scintigram in a patient with an absent right pulmonary artery. Incidental finding on investigation for possible pulmonary emboli.

View larger version (102K): [in a new window]   Figure 12. Axial MRI of absent left pulmonary artery (PA). Note absent left PA and hypoplastic ipsilateral hemithorax. The descending aorta is right-sided (arrow).

View larger version (98K): [in a new window]   Figure 13. Contrast enhanced CT image showing a left pulmonary artery originating from the right pulmonary artery (pulmonary sling) forming a loop behind the trachea (arrow) with collapse/consolidation of the right lung. (Courtesy of Dr H Alton.)

View larger version (23K): [in a new window]   Figure 14. Primitive veins of the thorax at 6 weeks (a) and the adult venous pattern (b). (Reproduced with permission, Moore KL. The developing human: clinically orientated embryology. WB Saunders Company, 1982.)

View larger version (70K): [in a new window]   Figure 15. Left-sided superior vena cava: (a) chest radiograph and (b) unenhanced CT. Note in (a) a left paramediastinal opacity fading superiorly (arrows) and absence of a normal similar structure on the right. In (b) the left-sided superior vena cava is indicated with an arrow.

View larger version (154K): [in a new window]   Figure 16. Partial anomalous pulmonary venous drainage. Chest radiograph showing a vascular opacity draining from the right lower zone to below the diaphragm – scimitar syndrome (arrows). (Courtesy of Dr S Darby.)

View larger version (53K): [in a new window]   Figure 17. Partial anomalous pulmonary venous drainage. CT showing (a) origin of an anomalous pulmonary vein and (b) its drainage into the brachiocephalic vein (arrows).