Giant ductal pseudoaneurysm in infancy: a lesson learnt the hard way

Description

A 7-month-old girl, ex-preterm (26-weeker), 4.5 kg, with 4 mm patent ductus arteriosus (PDA) underwent PDA device closure (Amplatzer duct occluder - ADO II 4x6 mm) elsewhere and was readmitted 4 days later with pericardial effusion. Needle pericardiocentesis drained 50 mL of haemorrhagic fluid. Septic screen was negative. Severe dyspnoea ensued 2 weeks later. Chest X-ray excluded lung pathology. Bedside echocardiogram showed PDA device in situ (online ), no residual ductus, vegetation or pericardial recollection, unobstructed flow in the pulmonary artery and descending aorta, normal pulmonary arterial pressures, and normal biventricular function. Curiously, a giant anechoic mass (22x25 mm) (online ) was visualised posteroinferior to the device with its neck communicating with lesser curvature of the thoracic aorta at the level of origin of the left subclavian artery (figure 1A,B). Intra-aneurysmal thrombus or aortic dissection was absent. We diagnosed giant ductal pseudoaneurysm with possible left bronchial compression.

Figure 1

(A) Parasternal short-axis transthoracic two-dimensional echocardiogram...

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