Interventional Radiology

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Newborn with increasing cardiothymic silhouette on serial chest films

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Patent Ductus Arteriosus

  • Image Findings: Plain films show enlarged pulmonary arteries and an enlarged cardiac silhouette. Angiography demonstrates filling of the pulmonary arteries from the aortic arch
  • In fetal life about 84% of the blood entering the pulmonary artery passes across the ductus into the descending aorta. About 12 to 24 hours after birth the ductus is functionally closed through contraction of the muscular wall. Anatomic closure follows 1 to 2 weeks later. For unknown reasons, the ductus arterious may remain patent , particularly in infants of low birth weight because of permaturity, in infants with respiratory distress syndrome, and in maternal exposure to rubella.
  • Altered hemodynamics arise from a PDA. In fetal life the shunt created by the ductus is from right to left because of the high pulmonary vascular resistance. With PDA, a left to right shaunt is created
  • Complications: the major complication related to PDA is the development of pulmonary arterial hypertension with resultant right to left flow reversal with cyanosis

Radiologic Findings:

  • Infant Chest film: hilar and segmental pulmonary arteries are enlarged, perihilar pulmonary edema that can advance to alveolar edema may be present. Enlarged cardiac ratio
  • Adult Chest film: “Ductus bump” is a localized dilatation adjacent to the descending aorta next to its arch at the entrance of the ductus. Ascending aorta and innominate artery may elongate. occasionally, the PDA may calcify
  • Angiographic findings: Left to right flow appreciated with aortic arch view. If flow is right to left, then a pulmonary artery injection will reveal the PDA

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