Document Detail

MDCT evaluation of the prevalence of tracheomalacia in children with mediastinal aortic vascular anomalies.
MedLine Citation:
PMID:  19204470     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: The purpose of this study is to determine the prevalence of tracheomalacia (TM) associated with different types of mediastinal aortic vascular anomalies in symptomatic children using paired inspiratory-expiratory multidetector computed tomography (MDCT). MATERIALS AND METHODS: The study group consisted of 15 consecutive symptomatic pediatric patients (12 males/3 females; mean age of 4.4 y; age range of 2 wk to 16 y) with mediastinal aortic vascular anomalies, who were referred for paired inspiratory-expiratory MDCT during a 35-month time period. Computed tomography (CT) angiography was also concurrently performed during the end-inspiration phase of the study. Two radiologists in consensus reviewed all CT images in a randomized and blinded fashion. End-inspiration and end-expiration CT images were reviewed for the presence and severity of tracheal narrowing and the type of mediastinal aortic vascular anomaly involved. TM was defined as > or =50% reduction in tracheal cross-sectional luminal area between end-inspiration and end-expiration. The presence of TM was correlated with the type of mediastinal aortic vascular anomaly and compared with the bronchoscopy results when available (n=9). RESULTS: Mediastinal aortic vascular anomalies included innominate artery compression (IAC) (n=6), a right aortic arch with an aberrant left subclavian artery (n=5), double aortic arch (n=3), and a left aortic arch with an aberrant right subclavian artery (n=1). Eight of 15 (53.3%) patients demonstrated TM. TM was seen in all 6 patients (100%) with IAC, 1 of 3 (33.3%) patients with double aortic arch, and 1 of 5 (20%) patients with a right aortic arch with an aberrant left subclavian artery. CT results were concordant with the results of bronchoscopy in all patients who underwent this procedure (n=9). CONCLUSIONS: Symptomatic pediatric patients with mediastinal aortic vascular anomalies have a relatively high prevalence of TM, especially those with IAC. Paired inspiratory-expiratory MDCT should be considered part of the routine preoperative evaluation of TM in symptomatic children with IAC and also has the potential to play a role in evaluating patients with other mediastinal aortic vascular anomalies.
Edward Y Lee; David Zurakowski; David A Waltz; Keira P Mason; Farhana Riaz; Amy Ralph; Phillip M Boiselle
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of thoracic imaging     Volume:  23     ISSN:  1536-0237     ISO Abbreviation:  J Thorac Imaging     Publication Date:  2008 Nov 
Date Detail:
Created Date:  2009-02-10     Completed Date:  2009-05-06     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8606160     Medline TA:  J Thorac Imaging     Country:  United States    
Other Details:
Languages:  eng     Pagination:  258-65     Citation Subset:  IM    
Department of Radiology and Medicine, Pulmonary Division, Children's Hospital Boston, Harvard Medical School, Boston, MA 02115, USA.
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MeSH Terms
Child, Preschool
Contrast Media
Infant, Newborn
Mediastinum / blood supply*,  radiography*
Radiographic Image Interpretation, Computer-Assisted
Retrospective Studies
Tomography, X-Ray Computed / methods*
Tracheomalacia / epidemiology,  radiography*
Vascular Malformations / epidemiology,  radiography*
Reg. No./Substance:
0/Contrast Media

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