Purpose or Case Report: -Review causes of pediatric abdominal aortic aneurysm (AAA)
-Optimize imaging in evaluation of pediatric AAA, including imaging of complications
-Discuss medical management and definitive treatment of pediatric AAA
Methods & Materials: This educational exhibit presents cases of pediatric AAA (ages 5 months to 15 years) from the author’s institutions. We also discuss image optimization, management & treatment of pediatric AAA.
Results: Review of selected cases of pediatric AAA
1. Massive non-mycotic infrarenal AAA with bilateral iliac aneurysms in a 5 month old
2. Fusiform AAA in a 15 year old with DOCK8 immunodeficiency syndrome
3. Mycotic AAA in an 8 year old with hypereosinophilia
4. Post surgical aneurysm after ganglioneuroblastoma resection in a 6 year old
5. Suprarenal aneurysms in an 8 year old with vasculitis
Additional discussion including:
- Discussion of causes: acquired (vasculitis, connective tissue disorder, hypertension, tuberous sclerosis, iatrogenic, trauma) versus congenital
- Discussion of optimal imaging modality and optimal imaging technique: CTA, MRA, US and conventional radiography
- Discussion of aneurysm characteristics: location, morphology, associated vascular abnormalities
- Discussion of complications: end organ ischemia, leak/rupture, thromboembolism and growth
- Discussion of medical management: anticoagulation, antihypertensives, serial imaging, treatment of underlying cause
- Discussion of operative treatment: native graft, prosthetic graft, cadaveric graft
Conclusions: - AAA are uncommon in the pediatric population. When they do occur they are often secondary to infection after invasive procedures. Less commonly, they are due to inflammatory diseases, connective tissue disorders, hypertension or iatrogenic trauma. Even more rare are congenital AAA.
- A variety of modalities can be utilized for diagnosis and follow-up of AAA. These include CTA, MRA, US and conventional angiography. Sedation and gating should be used to decrease motion when possible. MRI and US are non-ionizing modalities, but may be limited due to artifacts. CT uses ionizing radiation, but is readily available and has higher resolution. Catheter angiography is invasive and reserved for problem solving and possible intervention.
- Management of AAA involves a multidisciplinary team of pediatric specialists, pediatric radiologists, pediatric surgeons, and vascular surgeons.
-Treatment includes expectant waiting, treatment of complications, treatment of the underlying cause, and/or surgical repair.