Ductus Arteriosus Aneurysm with Organized Thrombus in a Neonate: Echocardiograms from Diagnosis to Resolution

A 7.5-lb female neonate was delivered at term, by means of a caesarian section, to a 26-year-old mother (her 2nd pregnancy). The infant had good Apgar scores but was transferred to the neonatal intensive care unit because of respiratory distress. She was treated for transient tachypnea and for bilateral spontaneous pneumothoraces. She improved with minimal respiratory support. Transthoracic echocardiography (TTE) revealed an aneurysmal ductus arteriosus (DA) with a large thrombus (Fig. 1). The patient was observed clinically and was started on 40 mg/d of aspirin. When the infant was 3 weeks old, TTE showed that the DA lumen was almost completely obliterated by the thrombus (Fig. 2). Two weeks later, TTE revealed complete resolution of the DA aneurysm and no thrombus (Fig. 3). The aspirin therapy was discontinued. Fig. 1. Transthoracic echocardiograms (parasternal short-axis views) show A) the pulmonary branch arteries and an aneurysmal ductus arteriosus with an evident thrombus (arrows); B) in color-flow Doppler mode, continuous flow through the ductus arteriosus into ... Fig. 2. Transthoracic echocardiograms. The parasternal short-axis views reveal A) the organization of the thrombus and almost complete obliteration of the ductus arteriosus lumen, and B) the absence of ductal flow, in color-flow Doppler mode. C) The suprasternal ... Fig. 3. Transthoracic echocardiograms. A) The parasternal short-axis view reveals confluent pulmonary branch arteries with unobstructed flow and complete resolution of the ductus arteriosus aneurysm and thrombus. B) The suprasternal view shows a patent aortic ...