Non-cardiovascular findings on chest CT angiography in children with congenital heart disease: How important are they?

Abstract

Background: There are only a few publications about the non-cardiovascular findings in children with congenital heart diseases explored by chest CT angiography. The purpose of our study is to evaluate the prevalence of non-cardiovascular findings on chest CT angiographies in children with congenital heart disease and to raise awareness about their importance among the radiologists.

Methods: We retrospectively reviewed the 272 chest CT angiographies performed in our pediatric radiology department between January 2017 and march 2021 and extracted the data of the 180 patients positive for a congenital heart disease. Then from that pool, we sorted out the non-cardiovascular findings into significant and non-significant in regard of their relevance or not in the patient's management.

Results: Non-cardiovascular lesions were found in 58% (105/180) of our patients, and 49% (88/180) of them presented at least one significant non-cardiac lesion. Lung and airways abnormalities were found in 41% (74/180) of the cases, representing the majority of the non-cardiovascular findings. Syndromic associations were found in 17% (28/180) of our patients, including 14 cases of heterotaxic syndrome.

Conclusion: Non-cardiovascular findings are common in children with congenital heart disease. Reporting these associated lesions is a requisite for an optimal therapeutic management of these children. Radiologists should never forget that a Chest CT angiography in children is first and foremost a chest CT.

Keywords: Chest CT angiography; Children; Congenital heart disease; Non-cardiovascular findings.

Fig. 1

Nature of the non-cardiovascular findings. Distribution of the 155 non-cardiovascular findings detected in the 105 patients positive for congenital heart disease (58% of 180)

Fig. 2

Splenic anomaly. Intra-cardiac total anomalous pulmonary venous return (TAPVR): the 4 pulmonary veins flow directly into the right atrium (a), associated with a levo-isomerism and inter-atrial communication (IAC). There is also a double superior vena cava (*b) and a polysplenia [yellow arrow (c)]

Fig. 3

Syndrome del 22q11.2 (Di George). Pulmonary atresia with ventricular septal defect (PAVSD), type II. Stenosis of the root of the pulmonary artery [blue arrows (a)]. Patent ductus arteriosus [circle (b)] and double superior vena cava [yellow arrows (c)]. No visibility of the thymus. Agenesis of the right kidney [red arrow (d)]

Fig. 4

Multiple associated anomalies. 14 years old, Marfan syndrome. Dilation of the aorta [black arrow (a)] and Valsalva sinus aneurysmal dilation [red arrows (b)]. Dilation of the pulmonary artery. Dorsal scoliosis (c) with thoracic deformation and hypoplasia of both lungs (d). Presence of a complete common mesentery; the small intestinal loops being located to the right of the colon [yellow arrow (e)]

Fig. 5

Williams Beuren syndrome. Supravalvular aortic stenosis associated with a tight stenosis of the root of the right pulmonary artery [arrows (a, c)]. Congenital lobar emphysema of the superior pulmonary left lobe (b, d).

Fig. 6

Kartagener syndrome. Situs inversus (a, b). Bilateral bronchiectasis (c, d)