Login | Users Online: 786  
Home Print this page Email this page Small font sizeDefault font sizeIncrease font size   
Home | About us | Editorial board | Search | Ahead of print | Current Issue | Archives | Submit article | Instructions | Subscribe | Advertise | Contact us
 


 
CASE REPORT
Year : 2008  |  Volume : 9  |  Issue : 1  |  Page : 24-26 Table of Contents     

Meandering vessels: A sign of arterial tortuosity on plain chest radiography


Department of Radiology, Hamad Medical Corporation, Doha, Qatar

Date of Web Publication17-Jun-2010

Correspondence Address:
Venkatraman Bhat
Department of Radiology, Hamad Medical Corporation, Doha
Qatar
Login to access the Email id

Source of Support: None, Conflict of Interest: None


Rights and PermissionsRights and Permissions

How to cite this article:
Bhat V, Al Muzrakchi A. Meandering vessels: A sign of arterial tortuosity on plain chest radiography. Heart Views 2008;9:24-6

How to cite this URL:
Bhat V, Al Muzrakchi A. Meandering vessels: A sign of arterial tortuosity on plain chest radiography. Heart Views [serial online] 2008 [cited 2022 Nov 29];9:24-6. Available from: https://www.heartviews.org/text.asp?2008/9/1/24/63679


   Introduction Top


Tortuous arteries traversing in unusual winding path (meandering) is a feature of vascular disease. These observations are often made in arteriography or on echocardiography [1] . In the elderly, these represent signs of atherosclerosis or hypertension whereas in children, they may be a sign of underlying systemic disease like Ehlers Donlos syndrome, Marfans syndrome or more recently recognized syndrome of arterial tortuosity [1],[2],[3] . Visualization of meandering vessels is possible in plain radiography of the chest because of high tissue contrast between the air filled lungs and fluid containing vascular structure. This finding on plain radiography may lead to diagnosis of unsuspected underlying disease. This report demonstrate such a classical example of meandering arteries on plain radiography of chest subsequently confirmed by multidetector computed tomography (MDCT) in a patient with clinical diagnosis of Ehlers Donlos syndrome.

A twelve years old male patient underwent plain radiography of chest for pulmonary assessment. Patient was known to be asthmatic with intermittent asthma medications. He had short stature and peculiar facial features. On physical examination, he had pectus excavatum and right inguinal hernia. Clinical examination of respiratory, cardiovascular system and CNS were unremarkable. He had no skin or joint abnormality. Along with clinical data and chest radiographic impression, the patient was suspected to have Ehlers Donlos syndrome.

Chest radiograph revealed elongated, tortuous aortic arch, projecting in to left lung field [Figure 1] a and b and lateral chest radiography showed a rounded opacity at upper lung field representing an unusually projecting aortic arch [Figure 2]a. The patient was also found to have a retro-cardiac shadow representing a hiatus hernia and was referred for contrast enhanced computed tomography for evaluation of mediastenal vascular structures. Multidetector spiral computed tomographic examination confirmed gross tortuosity of aortic arch, which was partially located within the left upper lobe [Figure 2]b. Additional arterial tortuosity was demonstrated in all branches of aortic arch, proximal and intrapulmonary branches of pulmonary arteries [Figure 2]c. Lungs were essentially normal except for a subpleural cyst adjacent to tortuous upper lobe pulmonary artery. Also hiatus hernia was confirmed in lower chest sections containing predominantly fatty components.


   Discussion Top


Tortuous, dilated aorta and pulmonary arteries are well known signs of Ehlers Danlos syndrome, Marfans syndrome and syndrome of arterial tortuosity in children [1],[3],[4] . Congenital heart diseases like patent ductus arteriosus and post-ductal aortic coarctation may also present with large aorta. In adults, atherosclerosis and hypertension are the main causes. When seen in the context of a known disease, the impact of observation is rather limited. However many patients present with unrelated symptoms and have chest radiography incidentally. In these patients, especially in the pediatric age group, appreciating signs of aortic and pulmonary tortuosity are vital, in order to suspect and make the correct diagnosis.

Intrapulmonary course of aorta is very rare, and results when there is extreme tortuosity and elongation of the aortic arch. It is uncommon to observe this anomalous aortic course. Our patient showed classical signs of aortic unfolding and elongation leading to a short intrapulmonary course, visible on plain radiography. Tortuous course of the pulmonary arteries were also present albeit less evident. In young patients, these signs are definite indication of underlying vascular abnormality as mentioned earlier. Though there is a non-invasive assessment of cardiovascular structures by echocardiography, it has limitations for extra-cardiac vascular structures. Magnetic resonance imaging must be considered as a valuable alternative wherever facilities are available. However, MDCT, has become the investigation of choice for vascular, pulmonary and airway assessment [5] . Associated complications like vascular stenosis and aneurysms can also be delineated. Additional lesions like hiatus hernia as shown in our patient are also best shown by computed tomography.


   Conclusion Top


Meandering vessels are signs of arterial tortuosity. In children, meandering vessels are seen in association with connective tissue syndromes and syndrome of arterial tortuosity. Plain chest radiography can reveal signs of aortic and pulmonary tortuosity, at times, leading to unsuspected underlying clinical condition. Definitive investigation is multidetector-computed tomography, which delineates the vascular anatomy along with associated lesions.

 
   References Top

1.Echocardiographic Features of Arterial Tortuosity: A New Syndrome? Andrej Robida, M.D., Vladimir Bricelj, M.D., Tohami A. Tohami, M.D. International Journal of Angiology. 2001,10:241-245.  Back to cited text no. 1      
2.A new type of Ehlers-Danlos syndrome associated with tortuous systemic arteries in a large kindred from Qatar. Abdul Wahab A, Janahi IA, Eltohami A, Zeid A, Ul Haque NF, Teebi AS. Acta Pedsitrcs, 2003 Apr; 92(4): 456-462.  Back to cited text no. 2      
3.Thoracic aortic aneurysm syndrome in children. Zanotti G, Vricella L, Cameron D. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2008:11-21.  Back to cited text no. 3      
4.A family exhibiting arterial tortuosity syndrome displays homozygosity formarkers in the arterial tortuosity locus at chromosome 20q13 SHE Zaidi, V Peltekova,S Meyer, A Lindinger, AD Paterson,, L-C Tsui , M Faiyaz-Ul-Haque and AS Teebi, Clin Genet 2004: 67: 183-188.  Back to cited text no. 4      
5.Paediatric multidetector CT angiography: spectrum of congenital thoracic vascular anomalies: Pictorial review : B Oguz, MD, M Haliloglu, MD and M Karcaaltincaba, MD. British Journal of Radiology 2007, 80: 376-383.  Back to cited text no. 5      


    Figures

  [Figure 1], [Figure 2]



 

Top
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    Introduction
    Discussion
    Conclusion
    References
    Article Figures

 Article Access Statistics
    Viewed14909    
    Printed170    
    Emailed0    
    PDF Downloaded126    
    Comments [Add]    

Recommend this journal