Diagnosis of congenital right pulmonary artery anomalies in children by transthoracic echocardiography and causes of missed diagnosis and misdiagnosis

doi:10.3877/cma.j.issn.1672-6448.2023.12.009

Abstract

Abstract:

Objective

To assess the diagnostic value of transthoracic echocardiography for congenital right pulmonary artery anomalies in children, and to summarise the reasons for their missed diagnosis or misdiagnosis.

Methods

Five children with right pulmonary artery anomalies who underwent transthoracic echocardiography at the Department of Ultrasound of Shanxi Children's Hospital from December 2020 to March 2023 were included in this study. The anomalies of the five children were confirmed by CT angiography (CTA) examination or surgery. The surgical diagnoses, ultrasound images, and diagnostic results were then analysed.

Results

Among the five cases of right pulmonary artery anomalies, one was identified as right pulmonary artery agenesis, while the remaining four were identified as right pulmonary artery anomalies originating from the ascending aorta (AORPA). Out of the five cases of right pulmonary artery anomalies, right pulmonary artery anomaly was misdiagnosed as coarse arterial ductus arteriosus by initial ultrasound in one case AORPA and aortopulmonary artery septal defect were missed in two cases. simple AORPA was correctly diagnosed by initial ultrasound in two cases, and combined intracardiac malformations were correctly diagnosed by preoperative echocardiography combined with CTA in three cases.

Conclusion

Transthoracic echocardiography can more accurately diagnose right pulmonary artery anomalies and the combined intracardiac malformations. However, it is prone to missed diagnosis or misdiagnosis. Scanning in high parasternal aortic views and enhancing the understanding of the anomalies can help improve the diagnosis rate of right pulmonary artery anomalies by transthoracic echocardiography.

Key words: Children, Congenital heart disease, Anomalous origin or developmental abnormality of the pulmonary artery, Unilateral pulmonary artery agenesis, Transthoracic echocardiography

Qiulian Wang, Ying Zhang, Chunmin Li, Bin Geng. Diagnosis of congenital right pulmonary artery anomalies in children by transthoracic echocardiography and causes of missed diagnosis and misdiagnosis[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(12): 1271-1275.

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URL: https://chaosheng.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1672-6448.2023.12.009

https://chaosheng.cma-cmc.com.cn/EN/Y2023/V20/I12/1271

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References 14

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例序	年龄	性别	临床表现	超声诊断	其他辅助检查	术中诊断
病例1	13岁	女	活动能力及耐力较同龄儿差，活动后心慌气短明显	首诊超声提示PDA、PAH；术前超声提示AORPA（远端型）、PDA、PAH	CTA诊断无名动脉根部见侧支血管连接右肺动脉；PDA	ARPA；左位PDA；右侧动脉导管连接无名动脉与右肺动脉远端；肺动脉压力重度增高
病例2	1岁2个月	男	支气管肺炎	首诊超声提示IAA、PAH；术前超声提示Berry综合征：包括（AORPA、APSD、IAA）；PDA、PAH	CTA诊断AORPA、APSD、IAA、PDA	APSD；AORPA；IAA；PDA；PAH
病例3	生后2 d	男	一般情况可	首次床旁超声提示ASD、PDA；复查超声提示AORPA、APSD、ASD，与胎儿期超声相符	CTA诊断AORPA、APSD、ASD	APSD；AORPA；ASD；PAH
病例4	生后13 d	男	呼吸短促	入院超声提示AORPA；合并PFO	无	AORPA；PFO；PAH
病例5	生后21 d	女	呼吸短促	入院超声提示AORPA；合并PFO、PDA	无	AORPA；PFO；PDA；PAH

例序	年龄	性别	临床表现	超声诊断	其他辅助检查	术中诊断
病例1	13岁	女	活动能力及耐力较同龄儿差，活动后心慌气短明显	首诊超声提示PDA、PAH；术前超声提示AORPA（远端型）、PDA、PAH	CTA诊断无名动脉根部见侧支血管连接右肺动脉；PDA	ARPA；左位PDA；右侧动脉导管连接无名动脉与右肺动脉远端；肺动脉压力重度增高
病例2	1岁2个月	男	支气管肺炎	首诊超声提示IAA、PAH；术前超声提示Berry综合征：包括（AORPA、APSD、IAA）；PDA、PAH	CTA诊断AORPA、APSD、IAA、PDA	APSD；AORPA；IAA；PDA；PAH
病例3	生后2 d	男	一般情况可	首次床旁超声提示ASD、PDA；复查超声提示AORPA、APSD、ASD，与胎儿期超声相符	CTA诊断AORPA、APSD、ASD	APSD；AORPA；ASD；PAH
病例4	生后13 d	男	呼吸短促	入院超声提示AORPA；合并PFO	无	AORPA；PFO；PAH
病例5	生后21 d	女	呼吸短促	入院超声提示AORPA；合并PFO、PDA	无	AORPA；PFO；PDA；PAH

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