Development of a perigraft seroma around modified Blalock-Taussig shunts: imaging evaluation.
OBJECTIVE
The modified Blalock-Taussig shunt is a synthetic shunt between the subclavian and pulmonary artery, frequently used in the treatment of children with pulmonary hypoperfusion caused by congenital heart disease. The development of a perigraft seroma is a known complication of this procedure. We sought to describe the imaging features of a perigraft seroma and to define an optimal diagnostic strategy in patients with a suspected perigraft seroma.


METHODS
Between January 1993 and December 1998, 96 children underwent 105 modified Blalock-Taussig shunt procedures. In eight children, 11 cases of perigraft seromas were identified. The mean age of these children at the time of operation was 3 years (range, 6 days to 5 years 8 months). Pre- and postoperative chest radiographs were routinely performed in the children in whom seromas had been found. Additional postoperative radiologic investigations consisted of thoracic sonography (in 11 cases), CT (in eight cases), and MR imaging (in two cases). In all cases of perigraft seroma, the modified Blalock-Taussig shunts were constructed through a posterolateral thoracotomy at the fourth intercostal space.


RESULTS
On average, the chest radiographs showed the first signs of the seroma on day 10 after the surgery (range, day 1-day 30). Using thoracic sonography, it was possible to visualize the perigraft seroma and the modified Blalock-Taussig shunt in eight (73%) of 11 cases. CT and MR imaging performed equally well in revealing perigraft seromas.


CONCLUSIONS
As was found in these critically ill children, sonography has an advantage over CT and MR imaging because of its portability and, therefore, capability for bedside use. We recommend the use of sonography as the initial imaging modality in suspected cases of perigraft seroma development.
van Rijn
Rick R
RR
Department of Paediatric Radiology, Sophia Children's Hospital, University Hospital Rotterdam, Ste. D-205, P. O. Box 2040, 3000 CA Rotterdam, The Netherlands.
Berger
Rolf M F
RM
Lequin
Maarten H
MH
Robben
Simon G F
SG
D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D002675:Child, Preschool; D005122:Exudates and Transudates; D005260:Female; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis*; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D013902:Radiography, Thoracic; D013348:Subclavian Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography