Four month-old baby with cyanosis Isabel Roca HU Vall Hebron
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Four month-old baby with cyanosis
Isabel RocaHU Vall Hebron
CLINICAL STATEMENTMale child 3 mo oldAdmitted because of cyanosis and hypoxemia, unmodified after O2 therapyChest X-Ray showed an opacity in the left upper field
Contrast-enhanced cardiac US showed a Right-to-left shunt
WHAT TO DO NEXT?1. CT scan2. Perfusion lung scan3. MRI4. Cardiosurgery
WHAT TO DO NEXT?1. CT scan2. Perfusion lung scan3. MRI4. Cardiosurgery
WHAT TO DO NEXT?1. CT scan2. Perfusion lung scan3. MRI4. Cardiosurgery
WHAT TO DO NEXT?1. CT scan2. Perfusion lung scan3. MRI4. Cardiosurgery
PERFUSION LUNG SCANPERFUSION LUNG SCAN
Cold defect at the left upper lobeHypoperfusion of the whole left lungSystemic activity: Right-to-Left shunt
QS/QP ratio = 1.28
Cold defect at the left upper lobeHypoperfusion of the whole left lungSystemic activity: Right-to-Left shunt
QS/QP ratio = 1.28
WHAT TO DO NEXT?1. CT scan2. Pulmonary artery angiography3. MRI4. Cardiosurgery
WHAT TO DO NEXT?1. CT scan2. Pulmonary artery angiography3. MRI4. Cardiosurgery
WHAT TO DO NEXT?1. CT scan2. Pulmonary artery angiography3. MRI4. Cardiosurgery
WHAT TO DO NEXT?1. CT scan2. Pulmonary artery angiography3. MRI4. Cardiosurgery
Treatment: selective embolisation
FOLLOW-UP
Chest x-ray
Perfusion lung scan
• No systemicactivity
WHAT TO DO NEXT?
1. CT scan2. Perfusion lung scan3. MRI4. Cardiosurgery
WHAT TO DO NEXT?
1. CT scan2. Perfusion lung scan3. MRI4. Cardiosurgery
8 months laterrelapse of cyanosis and hypoxemia, unmodified after
O2 therapy
CLINICAL FOLLOW-UP
WHAT TO DO NEXT?
1. CT scan2. Perfusion lung scan3. MRI4. Cardiosurgery
WHAT TO DO NEXT?
1. CT scan2. Perfusion lung scan3. MRI4. Cardiosurgery
8 months laterrelapse of cyanosis and hypoxemia, unmodified after
O2 therapy
CLINICAL FOLLOW-UP
WHAT TO DO NEXT?1. CT scan2. Perfusion lung scan3. MRI4. Cardiosurgery
WHAT TO DO NEXT?1. CT scan2. Perfusion lung scan3. MRI4. Cardiosurgery
Systemic activityRight-to-left shuntQS/QP ratio 1.25:1
•Pulmonary arterovenous fistulae may be multiple, and theymay open at different ages.
•Perfusion lung scan allows a non-invasive, sensitive and reproducible quantification of right-to left-shunts, thatcorrelates with hypoxemia
TEACHING POINTS
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