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Abnormal arterial anatomy and an unexpected intracranial haemorrhage
  1. Kieran Bannerman
  1. Neonatal Unit, Leeds General Infirmary, Leeds, UK
  1. Correspondence to Dr Kieran Bannerman, Neonatal Unit, Leeds General Infirmary, Leeds LS1 3EX, UK; kieran.bannerman{at}nhs.net

Abstract

A baby boy was born at term by spontaneous vaginal delivery to non-consanguineous parents following an unremarkable pregnancy. He was admitted to his local neonatal intensive care unit shortly after birth following several episodes of eye-rolling, colour change and apnoea. He had bilateral parieto-occipital cephalohaematomata, scattered petechiae and intermittent hypotonia. He was otherwise neurologically normal. A septic screen was completed and antibiotics and aciclovir were given. Cranial ultrasound, cerebral function monitoring and electroencephalography were normal. An echocardiogram demonstrated normal function and intracardiac anatomy but was suspicious for a dysplastic aortic arch and anomalous left pulmonary artery–aorta connection thus he was transferred to the regional paediatric cardiology centre where cardiac CT (figure 1) was undertaken. CT brain (figure 2) was performed simultaneously to delineate the cerebral vascular anatomy but demonstrated an intracranial lesion that accounted for the baby’s presentation.

Figure 1

3D reconstruction of cardiac CT demonstrates, from this posterior perspective, the course and calibre of the major systemic and pulmonary arteries and venous return.

Figure 2

CT brain was undertaken at the time of cardiac CT to establish the cerebral arterial vascular anatomy.

Questions

  1. What diagnosis was confirmed by cardiac CT?

    1. Scimitar syndrome

    2. Partial anomalous pulmonary venous drainage

    3. Major aortopulmonary collateral arteries

    4. Neonatal pulmonary embolus

    5. Arterial tortuosity syndrome

  2. What is the inheritance pattern of this condition?

    1. Sporadic

    2. Autosomal dominant with high penetrance

    3. Autosomal dominant with low penetrance

    4. Autosomal recessive

    5. X linked

  3. Which of these features is not associated with this diagnosis?

    1. Increased risk of stroke

    2. Pulmonary artery stenosis

    3. Abdominal ascites

    4. Joint hypermobility

    5. Facial dysmorphia

  4. What abnormality is demonstrated on CT brain?

    1. Neonatal stroke

    2. Subdural haematoma

    3. Normal cranial sutures

    4. Extradural haematoma

    5. Ruptured intracranial dermoid cyst

QuestionsAnswerscan be found on page 02.

  • Neonatology
  • Congenital abnormalities
  • Vascular
  • Imaging
  • Cardiology
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Footnotes

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Parental/guardian consent obtained.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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