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Multiplanar and Three-dimensional Multi–Detector Row CT of Thoracic Vessels and Airways in the Pediatric Population¹

¹ From the Edward Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110. Received August 8, 2002; revision requested October 8; revision received November 20; accepted January 2, 2003; updated September 15. Address correspondence to the author (e-mail: siegelm@mir.wustl.edu).

View larger version (133K): [in a new window]   Figure 1. Interrupted aortic arch in a 2-kg neonate. Volume-rendered sagittal reconstruction from CT data (collimation, 1.0 mm; table feed, 8 mm per rotation) shows a markedly hypoplastic transverse aortic arch (long upper arrow) and a large patent ductus arteriosus (PDA; long lower arrow) that supplies the distal aorta. Scanning began 12 seconds after the start of the contrast material injection. Total volume of contrast material was 4 mL. I = brachiocephalic trunk (innominate artery), short arrow = left common carotid artery.

View larger version (113K): [in a new window]   Figure 2. Multiplanar coronal reconstruction from CT data (collimation, 2.5 mm; table feed, 15 mm per rotation) of the trachea (T) and right and left main bronchi in a 15-year-old boy with cough. Coronal reformation obtained at end inspiration shows normal caliber of the trachea. Image was reconstructed by using 3-mm section thickness and 1-mm table intervals.

View larger version (115K): [in a new window]   Figure 3a. Reconstructions based on CT data (collimation, 2.5 mm; table feed, 15 mm per rotation) show normal trachea. (a) Coronal 3D volume-rendered image with lower opacity values shows normal-caliber trachea and right and left main bronchi. Lower opacity values render a more transparent image. (b) A 3D image from virtual bronchoscopy at level of main bronchi shows patency of right main bronchus. Orifice of the left main bronchus was best seen at a different level. This volume-rendered image with higher opacity levels and more color enhances the visibility of the airway surface.

View larger version (108K): [in a new window]   Figure 3b. Reconstructions based on CT data (collimation, 2.5 mm; table feed, 15 mm per rotation) show normal trachea. (a) Coronal 3D volume-rendered image with lower opacity values shows normal-caliber trachea and right and left main bronchi. Lower opacity values render a more transparent image. (b) A 3D image from virtual bronchoscopy at level of main bronchi shows patency of right main bronchus. Orifice of the left main bronchus was best seen at a different level. This volume-rendered image with higher opacity levels and more color enhances the visibility of the airway surface.

View larger version (144K): [in a new window]   Figure 4a. Double aortic arch. (a) Transverse contrast-enhanced CT image produced with variable-thickness display (ie, average of three images together to create thicker image) and maximum intensity projection shows double aortic arch surrounding the trachea (T), without airway compression. The two arches meet posteriorly. (b) Coronal volume-rendered CT image shows the relationship of the great vessels to both right arch (R) and left arch (L). A = ascending aorta, P = main pulmonary artery.

View larger version (137K): [in a new window]   Figure 4b. Double aortic arch. (a) Transverse contrast-enhanced CT image produced with variable-thickness display (ie, average of three images together to create thicker image) and maximum intensity projection shows double aortic arch surrounding the trachea (T), without airway compression. The two arches meet posteriorly. (b) Coronal volume-rendered CT image shows the relationship of the great vessels to both right arch (R) and left arch (L). A = ascending aorta, P = main pulmonary artery.

View larger version (133K): [in a new window]   Figure 5a. (a) Transverse CT and (b) multiplanar reconstruction images of coarctation in a newborn boy. Short-segment coarctation (arrow) is demonstrated on b, but the area of narrowing was not identified on a. (c) Coarctation in an adolescent patient. Descending aorta is narrowed (black arrowhead) just beyond the left subclavian artery (S), which is mildly dilated. Also note large internal mammary artery collateral vessel (white arrowheads). Posterior collateral intercostal arteries (arrow) are also seen.

View larger version (113K): [in a new window]   Figure 5b. (a) Transverse CT and (b) multiplanar reconstruction images of coarctation in a newborn boy. Short-segment coarctation (arrow) is demonstrated on b, but the area of narrowing was not identified on a. (c) Coarctation in an adolescent patient. Descending aorta is narrowed (black arrowhead) just beyond the left subclavian artery (S), which is mildly dilated. Also note large internal mammary artery collateral vessel (white arrowheads). Posterior collateral intercostal arteries (arrow) are also seen.

View larger version (150K): [in a new window]   Figure 5c. (a) Transverse CT and (b) multiplanar reconstruction images of coarctation in a newborn boy. Short-segment coarctation (arrow) is demonstrated on b, but the area of narrowing was not identified on a. (c) Coarctation in an adolescent patient. Descending aorta is narrowed (black arrowhead) just beyond the left subclavian artery (S), which is mildly dilated. Also note large internal mammary artery collateral vessel (white arrowheads). Posterior collateral intercostal arteries (arrow) are also seen.

View larger version (82K): [in a new window]   Figure 6. Postoperative coarctation in a 10-year-old boy. Sagittal volume-rendered CT reconstruction, viewed from behind, demonstrates an endovascular aortic stent (arrows). The left subclavian artery (S) is narrowed at its origin. C = left common carotid artery.

View larger version (86K): [in a new window]   Figure 7a. Annuloaortic ectasia secondary to Marfan disease. (a) Transverse contrast-enhanced CT scan shows a dilated ascending aorta (A). (b) Multiplanar coronal CT reconstruction demonstrates craniocaudal extent of dilatation. P = normal-caliber main pulmonary artery. (Case courtesy of Jack Sty, MD, Milwaukee, Wis.)

View larger version (83K): [in a new window]   Figure 7b. Annuloaortic ectasia secondary to Marfan disease. (a) Transverse contrast-enhanced CT scan shows a dilated ascending aorta (A). (b) Multiplanar coronal CT reconstruction demonstrates craniocaudal extent of dilatation. P = normal-caliber main pulmonary artery. (Case courtesy of Jack Sty, MD, Milwaukee, Wis.)

View larger version (135K): [in a new window]   Figure 8a. Extralobar pulmonary sequestration. (a) Transverse contrast-enhanced CT scan demonstrates feeding artery (arrowhead) arising from the proximal abdominal aorta (A). (b) Coronal volume-rendered CT image shows entirety of feeding artery (arrow) as it courses from aorta (A) to left lower lobe sequestration (S).

View larger version (110K): [in a new window]   Figure 8b. Extralobar pulmonary sequestration. (a) Transverse contrast-enhanced CT scan demonstrates feeding artery (arrowhead) arising from the proximal abdominal aorta (A). (b) Coronal volume-rendered CT image shows entirety of feeding artery (arrow) as it courses from aorta (A) to left lower lobe sequestration (S).

View larger version (112K): [in a new window]   Figure 9. Right hemitruncus. Coronal 3D volume-rendered CT image demonstrates right pulmonary artery (P) arising from proximal ascending aorta (A).

View larger version (130K): [in a new window]   Figure 10. Tetralogy of Fallot with failed right Blalock-Taussig shunt. Coronal volume-rendered CT image demonstrates multiple transpleural collateral vessels arising from a dilated tortuous right mammary artery (arrows).

View larger version (86K): [in a new window]   Figure 11a. Scimitar syndrome with partial anomalous venous return. Transverse CT scans obtained at the level (a) of the ventricles and (b) of the liver show anomalous pulmonary vein (arrow) entering the inferior vena cava (C) just below the junction with the right atrium. Note also slightly smaller right hemithorax and ipsilateral mediastinal shift. Right ventricle (V) is dilated due to left-to-right shunt. (c) Left oblique volume-rendered 3D CT image shows entire course of the anomalous vessel (arrow). Most of the right lung in this patient drained into the anomalous vein. Only a small part of the upper lobe drained normally. C = inferior vena cava.

View larger version (102K): [in a new window]   Figure 11b. Scimitar syndrome with partial anomalous venous return. Transverse CT scans obtained at the level (a) of the ventricles and (b) of the liver show anomalous pulmonary vein (arrow) entering the inferior vena cava (C) just below the junction with the right atrium. Note also slightly smaller right hemithorax and ipsilateral mediastinal shift. Right ventricle (V) is dilated due to left-to-right shunt. (c) Left oblique volume-rendered 3D CT image shows entire course of the anomalous vessel (arrow). Most of the right lung in this patient drained into the anomalous vein. Only a small part of the upper lobe drained normally. C = inferior vena cava.

View larger version (145K): [in a new window]   Figure 11c. Scimitar syndrome with partial anomalous venous return. Transverse CT scans obtained at the level (a) of the ventricles and (b) of the liver show anomalous pulmonary vein (arrow) entering the inferior vena cava (C) just below the junction with the right atrium. Note also slightly smaller right hemithorax and ipsilateral mediastinal shift. Right ventricle (V) is dilated due to left-to-right shunt. (c) Left oblique volume-rendered 3D CT image shows entire course of the anomalous vessel (arrow). Most of the right lung in this patient drained into the anomalous vein. Only a small part of the upper lobe drained normally. C = inferior vena cava.

View larger version (81K): [in a new window]   Figure 12. Tracheal stricture caused by prior trauma in a 12-year-old boy. Coronal volume-rendered CT images obtained at inspiration (A) and expiration (B) show smoothly marginated asymmetric narrowing above the bifurcation. Arrows = longitudinal extent of narrowing. Lack of change in airway caliber during the respiratory cycle indicates stenosis or fixed narrowing rather than tracheomalacia.

View larger version (62K): [in a new window]   Figure 13a. Tracheomalacia. (a) Sagittal reconstruction of CT data obtained at full expiration shows approximately 50% tracheal narrowing. (b) Coronal 3D volume-rendered reconstruction of CT data with lower opacity (transparency) values obtained during full inspiration shows normal-caliber trachea.

View larger version (71K): [in a new window]   Figure 13b. Tracheomalacia. (a) Sagittal reconstruction of CT data obtained at full expiration shows approximately 50% tracheal narrowing. (b) Coronal 3D volume-rendered reconstruction of CT data with lower opacity (transparency) values obtained during full inspiration shows normal-caliber trachea.