Four month-old baby with cyanosis - NUCLEUS

Four month-old baby with cyanosis

Isabel RocaHU Vall Hebron

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


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




Treatment: selective embolisation

FOLLOW-UP

Chest x-ray

Perfusion lung scan

• No systemicactivity

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



Systemic activityRight-to-left shuntQS/QP ratio 1.25:1

•Pulmonary arterovenous fistulae may be multiple, and theymay open at different ages.

•Perfusion lung scan allows a non-invasive, sensitive and reproducible quantification of right-to left-shunts, thatcorrelates with hypoxemia

TEACHING POINTS

Four month-old baby with cyanosis - NUCLEUS

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