First one with correct answer with justification win.

 

[size=20px]A child born with esophageal atresia has a chest radiograph suspicious for a right sided aortic arch. An echocardiogram fails to reveal any additional abnormalities.

 

The next best step in management of this patient with esophageal atresia and suspected right sided aortic arch is

 

A bronchoscopy.

 

B thoracoscopy.

 

C computerized tomography angiography.

 

D right thoracotomy.

 

E left thoracotomy.[/size]

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B

think again my dear

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E

think again my dear

(Untitled)

 

C

C

correct

 

The incidence of right sided aortic arch in patients with esophageal atresia is between 4% and 16%. Patients with a right sided arch are more likely to have a long gap atresia, more likely to have a cardiac anomaly, twice as likely to have perioperative complications and ten times as likely to have a vascular ring (38 versus 3.8%). Identification of these anomalies preoperatively helps significantly in operative planning.

 

Paying special attention to tracheal deviation or the course of an umbilical artery catheter on chest radiograph can alert the surgeon to the presence of a right sided aortic arch. Up to three quarters of patients with a right sided arch are missed on preoperative echocardiogram.

 

Because of the high incidence of vascular ring, most often an aberrant subclavian artery with a left patent ductus arteriosus, patients thought to have a right sided aortic arch should undergo additional diagnostic imaging, such as computerized tomography or magnetic resonance angiography, prior to repair.

 

Repair of esophageal atresia associated with a right sided aortic arch can be performed through either a right or left or staged bilateral thoracotomy (-ies). In cases associated with a vascular ring, left thoracotomy allows for division of the patent ductus which facilitates esophageal mobilization. Thoracoscopic repairs have been reported.