Figure 1. Frontal chest radiograph at age 6 months. A retrocardiac rounded mass is identified and splays the left main stem bronchus.
Figure 2. Computed tomographic scan of the chest at the level of the left atrium. Intravenous contrast enhancement shows that the retrocardiac mass enhances homogeneously and is closely associated with the thoracic aorta.
Figure 3. Magnetic resonance image of the chest (coronal T1-weighted sequence). There is flow void in the lesion that arises from the thoracic aorta with which it communicates via a broad neck. The lesion is a vascular structure with active blood flow.
Thoracic aortic aneurysm is an unusual complication of umbilical artery catheterization.1 Although umbilical artery catheters have been used since 1961, the first case report of an associated aneurysm was in 1976.2 From subsequent case reports, a common identified cause is sepsis, usually S aureus, as in this case.1- 4 The association of sepsis with aneurysm formation suggests seeding of the aortic wall secondary to localized trauma at the tip of the umbilical artery catheter.1,3,4
The differential diagnosis of the mediastinal mass found on chest radiograph in this child includes neurogenic tumor, esophageal or bronchogenic duplication cyst, or round pneumonia.3 A murmur, best heard at the back, should raise suspicion of an aortic aneurysm. This lesion displaced the left main bronchus, producing the patient's history of raspy breathing when supine. An esophageal duplication cyst was considered, and computed tomography was performed. Magnetic resonance imaging would have been a better initial study to evaluate for intraspinal extent of a neurogenic tumor.
Findings from computed tomographic scan included an aneurysm with contrast enhancement of the lesion contiguous with the lumen of the thoracic aorta. The magnetic resonance study was completed while the child was sedated to better depict the extent and neck of the aneurysm. This patient underwent successful aortic graft repair. Findings from histopathologic examination revealed that the lesion was not a true pseudoaneurysm, but the thinned aortic wall was fibrotic without acute inflammation.
Accepted for publication June 12, 1998.
Corresponding author: Daniel E. Long, MD, The Ohio State University Medical Center, Department of Diagnostic Radiology, 450 W 10th Ave, No. 255, Columbus, OH 43210.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
Thank you for submitting a comment on this article. It will be reviewed by JAMA Pediatrics editors. You will be notified when your comment has been published. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest*
Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more
Subscribe for full-text access to content from 1998 forward and a host of useful features
Activate your current subscription (AMA members and current subscribers)
Purchase Online Access to this article for 24 hours
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 2
Customize your page view by dragging & repositioning the boxes below.
and access these and other features:
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.