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IMAGING FOR RESIDENTS QUIZ Table of Contents  
Ahead of print publication
Kinking of the aorta in the third-trimester ultrasound scan


1 Department of Obstetrics and Gynecology, Entre O Douro E Vouga Hospital Center, Santa Maria da Feira, Portugal
2 Department of Obstetrics and Gynecology, Entre O Douro E Vouga Hospital Center, Santa Maria da Feira; Health Science Faculty, Beira Interior University, Covilhã, Portugal
3 Department of Pediatric Cardiology, Entre O Douro E Vouga Hospital Center, Santa Maria da Feira, Portugal

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Date of Submission31-Dec-2021
Date of Decision09-Mar-2022
Date of Acceptance27-May-2022
Date of Web Publication18-Aug-2022
 


How to cite this URL:
Martins MM, Saraiva S, Cunha S, Rasteiro C, Da Silva AM, Costa C. Kinking of the aorta in the third-trimester ultrasound scan. J Med Ultrasound [Epub ahead of print] [cited 2023 Mar 22]. Available from: http://www.jmuonline.org/preprintarticle.asp?id=354087





  Section 1 – Quiz Top


Case

A 40-year-old healthy woman, gravida 2, para 1 (vaginal delivery 7 years ago), was referred to our obstetrics department for ultrasound surveillance due to advanced maternal age. The first pregnancy was uneventful. Family history was unremarkable.

The first ultrasound scan was normal, but since it was performed after the ideal timing (at 16 weeks), aneuploidy screening was carried out with cell-free fetal DNA scanning, which presented low risk.

The second-trimester ultrasound scan at 20 weeks and 1 day of gestation, showed a live fetus with no apparent fetal abnormalities, nevertheless, because the cardiac examination was difficult, fetal echocardiography was performed at 21 weeks, which showed to be normal.

The patient was diagnosed with gestational diabetes at 26 weeks, and glycemic control was achieved with diet.

At 28 weeks, a third-trimester ultrasound scan was carried out, showing a live fetus in a cephalic presentation with an estimated fetal weight of 1392 g (90th percentile) and normal anatomy for the gestational age.

The third-trimester ultrasound scan was repeated at 34 weeks and 4 days of gestation, showing a live fetus in a cephalic presentation with an estimated fetal weight of 2480 g (50th percentile). Throughout the examination, an irregularity of the cardiac rhythm was detected (suggestive of cardiac extrasystoles). During cardiac assessment, an abnormal course of the aorta was identified, namely a prominent kinking in the proximal descending aorta with no significant stenosis nor frank aneurysm formation [Figure 1].
Figure 1: (a-c) A two-dimensional echocardiography sagittal view of the aortic arch at 34 weeks of gestation, showing an abnormal course of the aorta (white line) with a prominent and focal kinking (arrow) without frank aneurysm formation in the proximal descending aorta; (d) A sagittal view of the aortic arch with color-Doppler revealing a slight aliasing effect in the kinking/bulking area

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The fetal echocardiography at 35 weeks of gestation showed: situs solitus and levocardia with normal cardiac axis and normal atrioventricular concordance. The four-chamber view revealed a left ventricle/right ventricle proportion of 1.46 [Figure 2]a. The ventricular outflow tract views, three-vessel view, and three-vessel and trachea views were normal. The sagittal arch view revealed an elongation of the distal aortic arch, a focal kinking at the proximal descending aorta, and an absence of significant stenosis or enlarged collateral arteries [Figure 2]b. In addition, frequent supraventricular extrasystoles were visualized. The maternal assessment was unremarkable (no cardiac or medication history, and normal laboratory tests, including normal thyroid-stimulating hormone)[1].
Figure 2: (a) A two-dimensional echocardiography four-chamber view at 35 weeks, showing a left ventricle/right ventricle proportion of 1.46 (13.68/9.36) – normal value <1.5[1]; (b) A sagittal arch view with color-Doppler, revealing a focal kinking without frank aneurysm formation in the proximal descending aorta with no significant stenosis or enlarged collateral arteries and a slight aliasing effect across the lesion, and with no major hemodynamic abnormalities

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A healthy female newborn was delivered at 40 weeks. At 1 day of life, a transthoracic echocardiogram was performed, confirming the focal kinking described with no stenosis or collateral arteries [Figure 3].
Figure 3: Comparison between prenatal and postnatal findings: a two-dimensional echocardiography sagittal arch view at 35 weeks of gestation (a) and at day 1 of life (b) showing the abnormal course of the aorta with a prominent and focal kinking in the proximal descending aorta, without aortic stenosis. (ARCO AO: Aortic Arch; AOD: Descending Aorta; AP: Pulmonary artery)

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  What is the Diagnosis? Top


Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the forms, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that her name and initials will not be published and due efforts will be made to conceal her identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Quarello E, Stos B, Fermont L. Prenatal diagnosis of aorta coarctations. Gynecol Obstet Fertil 2011;39:442-53.  Back to cited text no. 1
    

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Correspondence Address:
Matilde Matos Martins,
Casa da Vila da Feira Street, Number 34, 3rd Left, 4520 293, Santa Maria da Feira, Aveiro
Portugal
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Source of Support: None, Conflict of Interest: None



    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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