Reverse 3 sign in barium swallow is seen in:
Correct Answer: Coarctation of aorta
Description: Ans-A Ref: OP Ghai, Textbook of Pediatrics: 7th edition, page: 421 Nelson's Textbook of Pediatrics 18th edition: page no 1901Explanation:Radiological signs of coarctation of aorta:Rip notching or dock sign is the notching of the under surfaces of posterior ribs extending from third to ninth ribs. It may be unilateral or bilateral and is seen only after the age of 6 yearsPost stenotic dilatation is the dilation of the aorta distal to coarctation3-sign is a combination of dilated left subclav ian artery above.stenosed coarcted segment in the middle and dilated post-stenotic aorta belowE-sign is seen on the lateral view on a barium swallow. This results from the dilated left subclavian artery and dilated post stenotic aorta indenting the barium filled oesophagus.Coarctation of the aortais produced by a deformity of the aortic media and intima. which causes a prominent posterior infolding of the aortic lumen.This deformity characteristically occurs at or near the junction of the aortic arch and the descending thoracic aorta.Cystic medial necrosis is a common occurrence at the level of coarctation and may predispose the aorta to infective endarteritis, intimal dissection, and aneurysm.Coarctation of the aorta accounts for 5% -10% of congenital cardiac lesions.It occurs with increased frequency among patients with Turner syndrome. 20%-36% of whom are affected.Clinical manifestations vary from congestive heart failure in infancy to hypertension with differential pressures between the upper and lower extremities in adulthood.Two classic radiologic signs associated with aortic coarctation are the figure-of-three sign and the reverse figure-of-three sign.The aortic segment affected by coarctation has a shape that resembles the number 3 on frontal chest radiographs.The number 3 is formed by dilatation of the left subclavian artery and aorta proximal to the site of coarctation, indentation of the site, and dilatation of the aorta distal to the site.This sign is seen in 50%-66% of adults with aortic coarctation.The reverse figure-of-threesign. a mirror image of the number 3, is observedon the left anterior oblique view during bariumesophagography in patients with aortic coarctation.Common radiologic signs in Congenital Heart DiseaseTransposition of Great arteriesEgg on side or Apple on a string apoearanceTotal anomalous pulmonary venous return5nowman or Figure of esght appearancePartial anomalous pulmonary venous returnScimitar signTetralogy of FallotBoot shaped HeartEbstein's anomalyBox shaped heartEndocardial Cushion defectGoose neck sign
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