Four month-old baby with cyanosis - NUCLEUS
Transcript of Four month-old baby with cyanosis - NUCLEUS
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
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