Chopra Mark,  Barrett Hannah,  Hutchinson J.,  Kiho Liina,  Arthurs Owen

Final Pr. ID: Poster #: CR-012

Ductus Arteriosus calcification is a poorly comprehended pathology occasionally reported on chest radiographs, more commonly on CT. The purpose of this educational abstract is to present the concepts surrounding ductal arteriosus (DA) calcification and reviews the literature to date.
We retrospectively searched the main medical literature (PubMed, MEDLINE, CINAHL and Google scholar databases) using the following keywords: “ductus arteriosus”, “ligamentum arteriosum”, “calcification”, “ductal”, “patent ductus arteriosus”, “children”, “paediatric”. Articles regarding ductus arteriosus calcification were further evaluated for citations.

Sixteen articles were found which dated back over nearly a century. Of these eight concerned a paediatric population and very few had histological confirmation. The majority highlighted that ductal calcification is more prevalent than previously thought. Ductal calcification was initially reported on the chest roentgen-ray in 1931 by Weiss. The increasing prevalence has been compounded by the use of the greater spatial resolution offered by modern CT scanners. A study in 2012 showed up to a third of children have ductal calcification on CT, with peak incidence is towards the end of the first decade in girls. There is conflicting opinion regarding the pathophysiology of ductal calcification, which may be either ductal aneurysmal thrombus regression, or more likely ligamentum arteriosum intimal and medial wall calcification.

This literature review illustrates the general paucity of histological data and suggests that the autopsy evidence favours intimal and medial wall calcification. Read More

Authors:  Chopra Mark , Barrett Hannah , Hutchinson J. , Kiho Liina , Arthurs Owen

Keywords:  Ductus arteriosus calcification, ligamentum arteriosum

Chopra Mark,  Barrett Hannah,  Hutchinson J.,  Kiho Liina,  Arthurs Owen

Final Pr. ID: Poster #: CR-013

Ductus Arteriosus calcification is a relatively common, typically unreported feature on plain film radiography. The more recent literature quotes a prevalence on unenhanced CT of between 37-61% of children and a peak at the age of 6-10 years. Adult studies have shown that calcification of the ligamentum arteriosum can occur alone or be associated with atherosclerotic and/or granulomatous calcification. We report two cases in whom they were identified as incidental findings on forensic post mortem CT, for whom we obtained histological confirmation.

Case 1: An 8 month old child who died in non-suspicious circumstances had incidental ductal arteriosus calcification reported on post mortem CT, following unremarkable skeletal survey. Intimal mural calcification was reported on histology at autopsy.

Case 2: A 19 month old child who died of aspiration underwent full skeletal survey and PMCT as part of the pre-autopsy imaging assessment. The skeletal survey revealed incidental ductus arteriosus calcification, initially reported as PDA clip, with correlation at CT. Intimal and medial mural calcification was reported on histology at autopsy.

These cases showed that ductal calcification was intimal and medial in nature. This is consistent with the current literature regarding mural calcification rather than thrombus regression calcification. Read More

Authors:  Chopra Mark , Barrett Hannah , Hutchinson J. , Kiho Liina , Arthurs Owen

Keywords:  Ductus arteriosus calcification, Post mortem, Non-accidental injury

Buckland Christopher,  Potts James,  Mawson John,  Culham James

Final Pr. ID: Poster #: EDU-001

Abstract: The Ductus Arteriosus (DA) plays an important role during fetal circulation. Failure to close at birth is a common event. In this poster we demonstrate the many other roles of the DA in cardiovascular and pulmonary disease. These lesions may impact the systemic circulation, the pulmonary circulation, or the airway and include coarctation, ductus-dependent pulmonary artery, and vascular rings. Read More

Authors:  Buckland Christopher , Potts James , Mawson John , Culham James

Keywords:  Ductus arteriosus, Fetal circulation, Medical imaging

Gilligan Leah,  Popescu Andrada,  Griffin Lindsay,  Rigsby Cynthia,  Bardo Dianna

Final Pr. ID: Poster #: EDU-003

The ductus arteriosus is normal structure of fetal circulation derived from the embryologic left 6th aortic arch that connects the aorta to the pulmonary arterial circulation. Patent ductus arteriosus (PDA) is a congenital cardiac anomaly in which the ductus arteriosus fails to undergo physiologic closure after birth. PDA is associated with prematurity, trisomy 21, and other diseases. When isolated, a PDA acts as a left to right cardiac shunt. In the setting of a right aortic arch, a PDA completes the vascular ring. A PDA may be treated with medical closure with indomethacin, endovascular closure, or surgical closure.

Several congenital heart defects are dependent on a PDA to maintain circulation either to the systemic or pulmonary circulations. In these cases of ductal-dependent postnatal circulation, the PDA can be kept open with prostaglandins.

Examples include:
- Pulmonary atresia without a ventricular septal defect
- Critical pulmonary stenosis
- Tricuspid atresia
- Severe Ebstein anomaly
- Severe tricuspid regurgitation
- Hypoplastic left heart syndrome
- Critical aortic valve stenosis
- Interruption of the aortic arch
- Severe coarctation of the aorta

Additional important anatomic and physiologic variations of PDA anatomy will be presented:
- Reverse oriented ductus
- To and fro blood flow
- Reversal of PDA blood flow
- Right ductus arteriosus
- Completion of a vascular ring

Other important structures to evaluate:
- Trachea and main bronchi which may be compressed by the PDA
- Main and branch pulmonary arteries which may be stenotic or have isolated origin from the PDA
- Aortic arch sidedness and caliber (arch hypoplasia, coarctation, interruption) which may only become physiologically apparent as the PDA closes
- Vascular ring which may include the PDA or its ligament as a component of the ring

The purpose of this education exhibit is to describe:
- Embryology of the ductus arteriosus
- Normal anatomy and blood flow physiology of the ductus arteriosus
- Anatomy and physiology of the ductus arteriosus in congenital heart disease
- Abnormalities of adjacent mediastinal structures (trachea, bronchi, aorta, pulmonary arteries) due to PDA Read More

Authors:  Gilligan Leah , Popescu Andrada , Griffin Lindsay , Rigsby Cynthia , Bardo Dianna

Keywords:  patent ductus arteriosus, congenital heart disease