Image 2
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Image 2
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The child underwent urgent cardac catheterisation. RV angio showed no filling of the right pulmonary artery. Image 2 is a left atrial angiogram. There is a left aortic arch: there is a right ductus arteriosus but it leads nowhere, and there is diffuse collateralisation of the right chest with a large internal mammary. These are arrowed on the full image.
Image 3
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Image 3 is a wedged right pulmonary vein angiogram: the lung parenchyma is stained
and a small, isolated right pulmonary artery fills retrogradely. This now explains
the plain film - the right lung is of normal size and normally ventilated but
is non perfused due to atresia of the right pulmonary artery origin. The distal RPA was once fed by the right ductus, which has closed off. This seems to have protected
it from RDS which has affected the left lung. In turn, the left lung is hyperperfused
which could well have accentuated the RDS.