MDCT evaluation of the prevalence of tracheomalacia in children with mediastinal aortic vascular anomalies

J Thorac Imaging. 2008 Nov;23(4):258-65. doi: 10.1097/RTI.0b013e31817fbdf7.

Abstract

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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Bronchoscopy
  • Child
  • Child, Preschool
  • Contrast Media
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Mediastinum / blood supply*
  • Mediastinum / diagnostic imaging*
  • Prevalence
  • Radiographic Image Interpretation, Computer-Assisted
  • Retrospective Studies
  • Tomography, X-Ray Computed / methods*
  • Tracheomalacia / diagnostic imaging*
  • Tracheomalacia / epidemiology
  • Vascular Malformations / diagnostic imaging*
  • Vascular Malformations / epidemiology

Substances

  • Contrast Media