主动脉弓畸形49 例的经胸超声诊断及漏误诊分析

目的探讨应用超声心动图诊断主动脉弓畸形的应用价值及漏误诊原因。方法回顾性分析2017年1月至2021年11月在安徽省儿童医院经CT血管成像(CTA)或手术证实的49例主动脉弓畸形病儿的影像学资料，分析各种主动脉弓畸形的声像图特点。结果49例主动脉弓畸形中，20例为右位主动脉弓(RAA)，16例为主动脉缩窄(CoA)，4例为主动脉弓离断(IAA)，6例为双主动脉弓(DAA)，3例为永存第五对主动脉弓(PFAA)。超声正确诊断39例，漏误诊10例，以上病例合并心血管畸形包括动脉导管未闭(PDA)、法洛四联症(TOF)、室间隔缺损(VSD)、房间隔缺损(ASD)或卵圆孔未闭(PFO)、主肺动脉窗(APW)、永存左上腔静脉(PLSVC)及迷走左锁骨下动脉(ALSA)等畸形。结论超声对主动脉弓畸形及其合并心血管畸形具有较高诊断价值，但对PFAA及ALSA易漏误诊，需结合其他影像学检查方法。

Transthoracic ultrasound diagnosis and misdiagnosis analysis of 49 cases of aortic arch malformation

Objective To explore the application value of echocardiography in the diagnosis of aortic arch malformation and the reasons for missed and misdiagnosed cases.Methods The imaging data of 49 children with aortic arch malformation confirmed by computed tomography angiography (CTA) or surgery in Anhui Children''s Hospital from January 2017 to November 2021 were retrospectively analyzed, and the sonographic features of various aortic arch malformations were analyzed.Results Of the 49 aortic arch malformations,20 were right aortic arch (RAA), 16 were coarctation of the aorta (CoA), 4 were severed aortic arch (IAA), 6 were double aortic arch (DAA), and 3 were persistent fifth aortic arch (PFAA). Ultrasound was correctly diagnosed in 39 cases and missed in 10 cases. The above cases were complicated with cardiovascular malformations, including patent ductus arteriosus (PDA), tetralogy of Fallot (TOF),ventricular septal defect (VSD), atrial septal defect (ASD) or patent foramen ovale (PFO), aortopulmonary window (APW), persistent left superior vena cava (PLSVC) and aberrant left subclavian artery (ALSA).Conclusion Ultrasound has high diagnostic value for aortic arch malformations and their associated cardiovascular malformations, but it is easy to miss and misdiagnose PFAA and ALSA, and other imaging methods should be combined.