Ligamentum arteriosum
Systemic & remnants · detail · Was: ductus arteriosus
Short fibrous band from the top of the pulmonary trunk at the origin of the left pulmonary artery to the undersurface of the aortic arch at the isthmus, just distal to the left subclavian artery: the closed ductus arteriosus.
Traced from the start
Detail
- Origin
- Ductus arteriosus, anatomically closed by 2-3 weeks and fully fibrosed over 1-3 months
- Nerve relation
- The left recurrent laryngeal nerve hooks under the arch immediately lateral to the ligamentum before ascending in the tracheo-oesophageal groove
- Fixation
- Tethers the mobile arch to the pulmonary trunk, so shear forces concentrate at the isthmus during sudden deceleration
When it goes wrong
High-speed deceleration (car crash, fall from height)
Traumatic aortic transection at the isthmus just distal to the left subclavian: widened mediastinum, tracheal deviation to the right and a left apical cap on chest X-ray
Aortic arch aneurysm, left atrial enlargement or ductal surgery
Left recurrent laryngeal nerve palsy with hoarse voice and bovine cough (Ortner syndrome)
Juxtaductal coarctation of the aorta
Upper-limb hypertension with weak, delayed femoral pulses, rib notching from intercostal collaterals and a '3' sign on chest X-ray; ductal tissue in the aortic wall contracts after birth and tightens the narrowing
Practise this structure
3 questions in the bank tagged Thorax.
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