Anomalous Artery Research Articles

The Feasibility Study of C1 Posterior Arch Crossing Screw Fixation in Adult Thai Population: A Computed Tomographic Morphometric Analysis Study

Objective: Atlantoaxial instability can be caused by various etiologies and surgical fixation is often required. Various methods have been described for atlantoaxial fixation. Screw fixation is associated with an increased risk of vertebral artery injury especially in patients with an anomalous vertebral artery location or abnormal bony anomalies. A new C1 posterior arch crossing screw fixation technique was proposed to reduce the risk of vertebral artery injury. The present study aimed to assess morphometric CT analysis of atlas for C1 posterior arch crossing screw fixation in Thai people. Materials and Methods: The present research was an observational study that reviewed 150 computed tomography (CT) scans of the patients who had neck trauma or any other complaint requiring craniocervical investigations. Atlantoaxial articulation deformities due to trauma, infections, neoplasm, congenital anomaly, inflammatory disease, incomplete CT scan analysis, and history of surgical intervention of the cervical spine were excluded. All the images were measured for the height of the posterior tubercle, the width of the posterior arch was measured bilaterally in three parts on the axial plane, part 1: medial of the VA groove, where the arch transforms into the VA groove, part 2: the middle part between the posterior tubercle and medial of the VA, and part 3: posterior tubercle, length of the screw, and the screw projection angle was calculated. Results: Out of the 139 CT scans analyzed, the mean measurement of posterior arch height was 7.45±1.03 mm, wherein 73.3% exceed 7 mm. The mean width of the left posterior arch in part 1, 2, and 3 was 4.50±0.70 mm, 4.90±0.70 mm, and 5.70±0.80 mm, respectively, and the width of the right posterior arch in part 1, 2, and 3 was 4.50±0.70 mm, 4.80±0.70 mm, and 5.60±0.80 mm, respectively. The mean crossing screw length of the Left and Right was 17.02±3.04 mm and 17.37±2.75 mm, respectively. The mean angle of screw of the Left and Right was 24.62±3.38 degrees and 24.78±3.57 degrees, respectively. There were no significant differences in these variables between gender or sides (p>0.05) except the mean angle of the screw between gender (p<0.05). Conclusion: C1 posterior arch screw fixation is feasible in the adult Thai population. Preoperative thin-cut CT is essential for planning successful posterior arch crossing screws placement. Keywords: C1 posterior arch, Computed tomography, Crossing screw fixation

Intralobar Pulmonary Sequestration with Anomalous Artery Arising from the Celiac Trunk

Pulmonary saequestration is a rare congenital malformation characterized by a dysplastic portion of lung parenchyma supplied by an anomalous artery originating from the aorta or its branches. The worldwide incidence of pulmonary sequestration among all congenital lung malformations in children ranges from 1.5% to 6.4%. There are two main types of pulmonary sequestration according to the localization of the malformation, i.e., intrapulmonary sequestration (dysplastic tissue located inside a lobe of the normal lung) and extrapulmonary sequestration. Our case presentation aims to make physicians aware of this rare anomaly which may be difficult to diagnose because of its oligosymptomatic course prior to first presentation. We present the case of a 10-year-old girl who suffered from a second episode of prolonged pneumonia of the left lower lobe. Contrast-enhanced-computed-tomography (CT) scan of the thoraco-abdominal segment of the aorta and its branches revealed intrapulmonary sequestration localized at the left lower lobe of the lung. The intrapulmonary sequester was perfused by a large artery arising from the celiac trunk. The girl underwent open surgery with ligation of the anomalous feeding artery and atypical pulmonary resection of the affected area of the left lower lobe. Postoperatively, the child recovered without any complications.

Prenatal diagnosis of vascular rings and outcome.

Background :Vascular rings (VRs) present with varied symptoms and may result in significant morbidity before an accurate diagnosis is made. Prenatal diagnosis may be useful to plan surgery after birth.Objectives :The purpose of the study was to see the feasibility of accurate diagnosis of VR during antenatal ultrasound examination and describe their outcome.Methods :This is a retrospective observational study between January 2014 and December 2019. Vascular rings were diagnosed on the basis of three vessel tracheal view and neck vessels arrangements on fetal echocardiogram. Postnatal evaluation by transthoracic echocardiography and computerized tomography angiogram was performed. Surgical repair was done as per standard indications.Results :A total of 35 cases of fetal VRs (median gestational age: 24 weeks [range: 19–35]) were diagnosed during the study period. There were four dichorionic diamniotic twin gestation pregnancies. The right aortic arch (RAA) with anomalous left subclavian artery (ALSA) was suspected in 31 fetuses, double aortic arch (DAA) in 3, and circumflex aorta in 1. Twenty-six (74%) patients had successful deliveries. One patient had a spontaneous miscarriage, 2 underwent termination, and 6 were lost to follow-up. Postnatal assessment showed RAA with ALSA in 18, DAA in 5, circumflex aorta in 2, and no abnormality in 1. Twenty-two (86%) were operated (RAA with ALSA: 17, DAA: 4, and circumflex aorta: 1) and four were waiting for surgery. Two patients died due to prematurity-related complications. All survivors are symptom free during follow-up (median: 2.24; range: 0.2–5.6 years).Conclusions :Fetal echocardiography enables prenatal diagnosis and planning of postnatal repair of VRs.

Ultrasound-Guided Stellate Ganglion Block to Treat Accidental Injection of Propofol in an Anomalous Radial Artery

Intra-arterial drug administration is a rare but potentially dreadful condition which can result in ischemia and gangrene of the hand. In the present case we accidentally injected propofol in an anomalous radial artery during anesthesia induction. Serial ultrasound-guided stellate ganglion blocks were applied to salvage the limb of the patient by promoting arterial blood flow. This is probably the first reported case of accidental intra-arterial injection of propofol being managed with stellate ganglion block.

Retroaortic anomalous coronary artery visualization on transthoracic echocardiogram

Incidental findings are not uncommon in echocardiography. A transthoracic echocardiogram (TTE) of an adult woman with arterial hypertension showed a tubular structure with hyperechoic walls in the atrial side of the atrioventricular groove in apical views. Coronary computed tomography angiography correlated this finding with a retroaortic course of the anomalous circumflex artery (retroaortic anomalous coronary artery [RAC], benign coronary artery variant). Recently described as the RAC sign on TTE, practitioners should be aware of this finding to avoid mistaken it as artifacts, catheters/leads, or calcified mitral annulus.

Focal Nodular Hyperplasia: The 7 Characteristic Features on Imaging

Focal nodular hyperplasia or FNH is the second most common benign liver tumour after hemangiomas. It is caused by abnormal alignment of hepatocytes, due to hypoperfusion or hyper perfusion in the hepatic lobule, from anomalous arteries [1-2]. It affects women mostly, in their reproductive age, and is usually asymptomatic, discovered incidentally through imaging, however, sometimes when enlarged it may cause discomfort and vague abdominal pain. Magnetic Resonance Imaging (MRI) is the method of choice for its diagnosis. The importance of recognizing FNH resides in its differential diagnosis: Hepatic adenoma, Hepatocellular carcinoma and hypervascular metastases (Figure 1). To confirm diagnosis, there are 7 characteristic features on imaging: 1. It is a homogeneous, non-capsulated lesion, with well-defined margins that are sometimes lobulated. 2. It is isoechoic on ultrasound. 3. In MRI: It is isointense on T1 weighted images or slightly hypointense and isointense on T2 weighted images or slightly hyperintense, because it contains disorganized hepatocytes, thus, signal stays homogeneous to liver signal 4. Surrounded liver parenchyma is respected. 5. It contains a central scar that may be seen in 50%-80% of the cases. 6. Contrast enhancement is typically intense and homogeneous at arterial phase, and becomes iso intense in the late phase. The central scar is hypointense in arterial phase, but becomes enhanced in the late phase. It presents no wash out. 7. It contains a feeding arteriole that develops towards the central scar. When asymptomatic, Patients only need an imaging follow up and no treatment is required, however, when symptomatic, surgical resection is necessary. Keywords: Liver; Focal; Lesion; Imaging; FNH References [1] Venturi A, Piscaglia F, Vidili G, Flori S, and Righini R, et al. (2007) Diagnosis and management of hepatic focal nodular hyperplasia. J Ultrasound. 10:116-127. [2] Matos AP, Velloni F, Ramalho M, AlObaidy M, and Rajapaksha A, & Semelka, et al. (2015) Focal liver lesions: Practical magnetic resonance imaging approach. World J Hepatol. 7: 1987-8

Primary Percutaneous Coronary Intervention in an Anomalous Left Circumflex Artery: Search for the Hidden Culprit

Congenital coronary anomalies are rarely detected in patients undergoing diagnostic coronary angiography. They pose a challenge in delay to identify the anomalous artery as well as difficulty in engaging the anomalous vessel. The present case report was of 56-years-old male patient presented with acute onset of chest pain. On evaluation, his electrocardiogram was suggestive of ST segment elevation in inferior leads. He underwent diagnostic coronary angiogram which revealed totally occluded Left Circumflex Artery (LCx) arising anomalously from right coronary osteum. Primary Percutaneous Coronary Intervention (PCI) of LCx could not be performed with routine guide catheters necessitating the use of special multipurpose guide catheter with balloon support. The case highlights the need for the knowledge of coronary anatomy and anomalous origins of coronary arteries and the selection of appropriate guiding catheters and coronary wires.

Intramucosal esophageal dissection after esophagogastroduodenoscopy: two case reports

Introduction: Intramucosal esophageal dissection (IED) is an uncommon disorder, described as the separation of the mucosa and/or submucosa from deeper muscular layers due to abrupt increase in intraesophageal pressure. Case presentation: The first case il that of a 52 – years old female patient who underwent an esophagogastroduodenoscopy for control. After the procedure an extensive subcutaneous emphysema of the neck and a massive pneumomediastinum occurred. The patient was successfully treated with a conservative approach. The second case is that of a 43-years old male patient affected by Down’s Syndrome, who underwent an esopagogastroduodenoscopy because of persisting dysphagia. The endoscopic showed the presence of a serrated stricture at 20 centimeters from dental arcade. After the procedure he fell dysphagia. A neck-chest TC-SCAN showed superior and posterior pneumomediastinum and subcutaneous emphysema, without signs of mediastinitis. The patient was successfully treated with conservative approach. After a few days, a new chest CT-SCAN showed the presence of an anomalous right subclavian artery arising from the descending part of the aortic arch, causing dysphagia lusoria. Discussion: The causes of IED include iatrogenic instrumentation, hemostatic applications, mucosal injuries from ingestion of sharp foreign body, or spontaneous. A fluoroscopic upper gastrointestinal series or upper gastrointestinal endoscopy has been widely used to diagnose IED. CT and magnetic resonance are useful for differential diagnosis. In the absence of signs of mediastinitis management is conservative. Conclusion: CT SCAN should be the first exam to perform in the suspicion of IED. The first line treatment should be conservative. In case of the onset of complications and in patients who are refractory to conservative management, endoscopic or surgical treatment are indicated.

The vascular origins of antero-medial tibial bowing in congenital fibular deficiency.

Anteromedial bowing and shortening of the tibia are intrinsic features of limbs with congenital fibular deficiency (CFD). Tibial bowing occurs more frequently when the fibula is radiographically absent rather than deficient. The bowing has been attributed to rapid longitudinal growth of the tibial anlage coupled with anteromedial tibial bending moments of the posterior crural and lateral peroneal musculature unopposed in the absence of a fibular strut. Eccentric mechanical loading results in asymmetric mineral deposition and thickening of the diaphyseal cortex. Skeletogenesis depends upon an intimate interplay between the normally prefigured tibial cartilage anlage and beginning muscular contractile actions during initial vascularization of the anlage, while the embryonic limb vasculature is undergoing a series of transitions. A diaphyseal periosteal collar normally forms at the site of nutrient artery invasion and stabilizes the growing anlage. In CFD however, arteriography consistently reveals anomalous tibial nutrient arterial branches, which originate from a primitive axial artery rather than from the usual posterior tibial artery. These anomalous nutrient arteries enter the tibial shaft at the posterior aspect of the proximal metaphysis, establishing an eccentric bone collar. The developing vasculature of the embryonic limb is responsive to the then most metabolically active tissues. Disruption of the reciprocal relationship between the transitioning vasculature and the developing long bones is pivotal in producing the diverse skeletal malformations of the congenital short limb (CSL). Embryonic vascular dysgenesis contributes not only to the well-recognized congenital tibial and fibular shortenings but also predisposes to congenital anteromedial bowing of the tibia.

Managing the Anomalous Vertebral Artery in C1-C2 Stabilization for Congenital Atlantoaxial Instability.

Objectives This study aimed to demonstrate the technique of handling the anomalous vertebral artery in congenital atlantoaxial instability. The vertebral artery course can be variable in congenital atlantoaxial instability, especially if there is assimilation of atlas. The surgical technique to stabilize the atlantoaxial joint should ensure the patency and safety of the vertebral artery and prevents devastating stroke. Computed tomography (CT) angiography of the vertebral artery is mandatory in planning the surgical strategies. The vertebral artery can be injured during dissection of soft tissues between atlas and axis and can be compromised during distraction and instrumentation. The vertebral artery needs to be mobilized based on the tortuosity in the course during instrumentation and prevents compression of the artery against bony structures or screw heads. The vertebral artery has to be identified earlier in the course of dissection and should protect it. It is also imperative to choose the surgical approach that can be performed under vision using operative microscope rather than adapting blind procedures like transarticular screw. Here, in our present case, we demonstrate the technique of mobilizing the vertebral artery which was coursing medially preventing the access for the instrumentation and perform stabilization of atlantoaxial joint using Goel–Harms technique, and prevent its compression after placement of screw by deroofing the bony ridges of axis ( Figs. 1 and 2 ). We also emphasize the various technical nuances during the stabilization with distraction of joint space of atlas and axis. The link to the video can be found at: https://youtu.be/pgURpF_jACc .

Abstract 16079: The Cusp of Life: Anomalous Origin of All Coronary Arteries From a Single Cusp

Introduction: Anomalous origin of coronary arteries has a prevalence of 1% in the population and is independently associated with a risk of sudden cardiac death. While an anomalous coronary artery arising from the opposite sinus is rare, all three coronary arteries arising from separate ostia in a single cusp is an extremely rare phenomenon. Case: A 48-year-old male with history of hypertension presented with fevers, cough and shortness of breath of 3 days duration. CXR demonstrated multi-lobar pneumonia and serology returned positive for Influenza A. Treatment was initiated with oseltamivir, vancomycin and piperacillin-tazobactam. Subcutaneous heparin was initiated for VTE prophylaxis. On day 3, the patient developed acute hypoxic respiratory failure from flash pulmonary edema necessitating intubation and mechanical ventilation. ECG revealed ST segment elevation in leads II, III, aVF, V5 and V6 (Fig. 1A). He was taken for urgent cardiac catheterization. Coronary angiography revealed anomalous origins of the left circumflex (LCX) and left anterior descending (LAD) arteries arising from the right coronary cusp (RCC) (Fig. 1B & 1C). 99% thrombotic occlusion of the distal right coronary artery was identified as the culprit lesion (Fig 1D). Percutaneous coronary intervention with a 4 x 30 mm drug-eluting stent was performed. Discussion: Absence of the left coronary artery originating from the left coronary sinus should raise suspicion for a coronary anomaly. While an anomalous LCX artery originating from the RCC is seen in 0.7% individuals, the LAD artery arises from the RCC is seen in 0.15% of people. All three coronary arteries arising from the RCC is extremely rare. An abnormal take-off angle, compression between the aorta and the pulmonary trunk, slit-like ostia, coronary hypoplasia and accelerated atherosclerosis are responsible for the increased risk of coronary events in this population.

Abstract 16067: Unique Challenge of Acs - Anomalous Left Main Coronary Artery From Right Coronary Cusp

Introduction: Anomalous aortic origin of coronary arteries (AAOCA) is uncommon congenital anomalies of the coronary circulation. Anomalous left main coronary artery (LMCA) originating from the right cusp is one of the rarer anomalies (incidence ~ 0.03% of patients undergoing coronary angiography). Mostly asymptomatic, however, this may become clinically significant with symptoms ranging from atypical chest discomfort to sudden cardiac death. We present a case of anomalous origin LMCA from the right coronary cusp. Case presentation: A 47-year-old female presented to the ED with three days of substernal chest pressure at rest. BP 106/71 mmHg, pulse 72 bpm, normal regular heart sounds, and clear lungs. The ECG showed new anterolateral T-wave inversions. Troponin-I was 0.31 ng/ mL. Echocardiogram showed normal LVEF without focal wall motion abnormalities. Coronary angiography revealed a dominant patent RCA without any disease. LMCA originated from the right coronary cusp with focal 90% ostial LAD stenosis. The rest of the coronary tree was free of disease. CABG with LIMA to LAD and SVG to OM1 was performed. Discussion: AAOCA presents a unique challenge to diagnosis and management. CT coronary angiogram or magnetic resonance angiography is recommended for more accurate delineation of the course of the coronary vessel. The diagnostic challenge to effectively engage the anomalous artery and to obtain coronary angiogram to delineate anatomy is critical in further management. As seen in our case, this is easy to overlook and in the acute event could lead to unnecessary delay.

CT angiographic evaluation of the V3 vertebral artery course in cases of occipitalized atlas, a study of 25 cases

ObjectivesTo study the relationship of the 3rd segment of the vertebral artery to the posterior arch of the atlas in patients with occipitalized atlas, using CT angiography. MethodsA retrospective study of 25 cases with complete or partially occipitalized atlas who underwent CT angiography evaluation. Fifty vertebral arteries were analyzed in relation to the respective/related half of the posterior arch of the atlas. ResultsOut of 50 vertebral arteries, 35 (70%) were anomalous; 31 (62%) traversed though bony canal between the fused occiput and atlas, and 4 (8%) coursed between C1 and C2 (C2 segmental type of vertebral artery). Except one, all anomalous vertebral arteries were associated with a fused corresponding side of posterior arch of atlas. ConclusionThe V3 portion of the vertebral artery assumes an anomalous course at the craniovertebral junction in most cases of occipitalized atlas, and this is strongly determined by the fusion status of the posterior arch of the atlas. Aberrations in its course are still seen despite expectations based on this fusion status. Preprocedural CT Angiography provides accurate information of its course to prevent iatrogenic VA injuries. Advances in knowledgeCT Angiography should be performed before any procedures at the craniovertebral junction in cases of occipitalized atlas to prevent iatrogenic, potentially catastrophic injuries to vertebral artery due to its anomalous course in most of these cases. There are very few such studies in the literature, none in radiology literature. We also describe some rare cases, including a case never described in any literature.

Computed tomographic angiography to analyze dangerous vertebral artery anomalies at the craniovertebral junction in patients with basilar invagination

ObjectiveFailure to detect dangerous anatomic vertebral artery anomalies (AVAAs) and dangerous functional vertebral artery anomalies (FVAAs) at the craniovertebral junction (CVJ) in patients with basilar invagination (BI) can result in major complications such as intraoperative vertebral artery injury, brain infarctions, and even death. Iatrogenic vertebral artery injury is a rare but severe complication of cervical spine surgery. We aimed to evaluate dangerous vertebral artery anomalies at the CVJ in patients with BI using computed tomographic angiography (CTA). MethodsCTA images of 61 BI patients were retrospectively analyzed to evaluate AVAAs and FVAAs at the CVJ. Dangerous AVAAs include a persistent first intersegmental artery (FIA), fenestration of the vertebral artery (FEN), and posterior inferior cerebellar artery with an extradural C1/2 origin (PICA-C1/2). Dangerous FVAAs include a dominant vertebral artery (DVA) and hypoplastic vertebral artery ending in the PICA (HVA-PICA) without joining the basilar artery. ResultsOverall, 31 female and 30 male patients (mean age, 42.3 years) were included. The incidences of FIA, FEN, and PICA-C1/2 were 29.5 % (18/61), 3.3 % (2/61), and 3.3 % (2/61), respectively, whereas the incidences of DVA and HVA-PICA were 36.1 % (22/61) and 1.65 % (1/61), respectively. ConclusionDangerous vertebral artery anomalies at the CVJ have a high incidence in patients with BI. Preoperative CTA is highly recommended in such patients to identify anomalous vertebral arteries and reduce the risk of intraoperative injury.

Anatomical characteristics of anomalous left coronary artery from the opposite sinus (left-ACAOS) and its clinical relevance: A serial coronary CT angiography study.

BackgroundAnomalous left coronary artery from the opposite sinus (left-ACAOS) is a rare congenital heart disease. While “interarterial course” is considered as the malignant anatomic feature for these patients, a number of patients with left-ACAOS, who don’t follow the above anatomic pattern, were reported with ischemic symptoms.PurposeThis study aims to evaluate the anatomic characteristics of left-ACAOS and their clinical relevance.MethodsThe coronary computed tomography angiography (CCTA) data from 44 patients with 46 left-ACAOS vessels were retrospectively included. Patients were divided into 2 groups: those with ischemic symptoms (n = 19) and those without ischemic symptoms (n = 25). Baseline clinical characteristics were recorded and the follow-up was done by telephone. CCTA images were reviewed for anomalous coronary artery, take-off angle and level, ostia morphology and grading, proximal narrowing, anomalous course and atherosclerotic plaques.ResultsThe prevalence of left-ACAOS was approximately 0.09% among 48, 719 consecutive patients referred for coronary CTA in our institution. Right sinus of Valsalva (RSV) was the most common origin (36/46, 78.26%). Left-ACAOS arising from right coronary artery (RCA) had narrower proximal segment (P = 0.014) and more prone to atherosclerosis (P = 0.040) than left-ACAOS arising from right sinus of Valsalva (RSV). Proximal narrowing severity (P < 0.001) and degree of maximal coronary stenosis (P = 0.034) of the anomalous left artery was higher in patients with ischemic symptoms than those without. Of note, no MACE was recorded during a mean follow-up of 43.4 ± 26.2 months.ConclusionLeft-ACAOS arising from RCA seems to be more prone to atherosclerosis than other subtypes. Proximal narrowing was more severe in patients with ischemia symptoms, which may contribute to risk stratification and clinical management.

Evaluation of the factors related to difficult ultrasound-guided radial artery catheterization in children under two years old: a prospective observational study

Introduction Although ultrasound guidance has significantly improved the success rate of radial artery catheterization, the failure rate in small children is still high. For the further improvement of success rate, we prospectively evaluated the factors that make ultrasound-guided radial artery catheterization difficult in small children under two years old. Methods From October 2018 to September 2019, patients under two years old who required radial artery catheterization for surgery were enrolled. After collecting the anatomical characteristics of the radial artery using ultrasound at the puncture site, ultrasound-guided radial artery catheterization was performed by one experienced anesthesiologist and recorded as a movie clip for further analysis. The primary outcome was to identify the factors related to the first attempt failure. The factors associated with the total duration of the procedure until success were also evaluated. Results A total of 183 children were included in the analysis. A radial artery cross-sectional area of 1 mm2 or less (OR [95% CI]: 5.26 [2.48–11.18], P Discussion A radial artery cross-sectional area of 1 mm2 or less, and the presence of an anomalous radial artery branch significantly increased the difficulty of ultrasound-guided radial artery catheterization in small children under two years old. In patients of these ages, pre-procedural ultrasound scanning to find an optimal site for catheterization may increase the first-attempt success rate. However, further studies are needed to verify the usefulness of pre-procedural scanning.

Coronary Artery Anomalies in Tetralogy of Fallot Patients Undergoing CT Angiography at a Tertiary Care Hospital.

BackgroundThe aim of this study was to determine the frequency of coronary artery anomalies (CAAs) in Tetralogy of Fallot (TOF) patients undergoing computed tomography (CT)-angiography in a tertiary care hospital.MethodologyIn this observational study, we included consecutive TOF patients undergoing CT-angiography without prior history of cardiac surgery or congenital heart disease. CAAs were defined based on either origin or course of the artery.ResultsOut of 441 TOF patients, the prevalence of CCAs was 3.6% (16), of which 13 were below 18 years of age. Anomalous left main artery was observed in six (1.4%) patients, followed by left anterior descending artery and right coronary artery, observed in four (0.9%) patients each, and two (0.5%) patients had a single coronary artery originating from the left coronary cusp with an interarterial course.ConclusionsCAAs were observed in a significant number (3.6%) of TOF patients. A CT-angiographic assessment before surgical correction would help identify the exact anatomy for better surgical planning to minimize complications.

Evaluation of the factors related to difficult ultrasound-guided radial artery catheterization in small children: A prospective observational study.

Although ultrasound guidance has significantly improved the success rate of radial artery catheterization, the failure rate in children is still high. For the further improvement of success rate, we prospectively evaluated the factors that make ultrasound-guided radial artery catheterization difficult in children under two years old. From October 2018 to September 2019, patients who required radial artery catheterization for surgery were enrolled. After collecting the anatomical characteristics of the radial artery using ultrasound at the puncture site, ultrasound-guided radial artery catheterization was performed by one experienced anaesthesiologist. The primary outcome was to identify the factors related to the first attempt failure. The factors associated with the total duration of the procedure until success were also evaluated. A total of 183 children were included in the analysis. A radial artery cross-sectional area of ≤1mm2 (odds ratio [OR]=5.26; 95% confidence interval [CI], 2.48-11.18; P<.0001) and the presence of an anomalous radial artery branch (OR=3.37; 95% CI, 1.43-7.95; P=.005) were independent predictors of first-attempt failure during ultrasound-guided radial artery catheterization. The total procedure time was also negatively associated with the small cross-sectional area (P<.001). A cross-sectional area of ≤1mm2 and the presence of an anomalous branch of radial artery significantly increased the difficulty of ultrasound-guided radial artery catheterization in children under two years old. In patients of these ages, pre-procedural ultrasound scanning to find an optimal site for catheterization may increase the first-attempt success rate although further studies are needed to verify our results. Clinical Research Information Service (https://crits.nih.go.kr, October 6, 2018 [KCT0003239]; Principle investigator: Jong-Hwan Lee).

Anomalous systemic artery to the non-sequestrated lung: multi-slice computed tomography features.

Anomalous systemic artery to the non-sequestrated lung: multi-slice computed tomography features.

Prenatal sonographic diagnosis of partial left pulmonary artery sling: A rare case report

Pulmonary artery sling is a rare congenital vascular anomaly. Partial anomalous left pulmonary artery is even rarer and no in utero observation has yet been reported. Here, we present the ultrasonographic findings of a 38-year-old woman at 32 weeks of gestation whose fetus showed a normal bifurcation of the pulmonary trunk into the right and left pulmonary arteries, but an anomalous origin of the left lower lobe pulmonary artery from the right pulmonary artery. These findings were confirmed by postnatal echocardiography and thoracic computed tomography.