Distal tracheal compression

The consultants concur that distal tracheal stenosis is a challenging problem in the pediatric patient but don't all agree on the presentation or management. Drs. Cotton and Crysdale agree that these children are usually seen with biphasic stridor. Dr. Parsons believes that biphasic stridor is not particularly common but inspiratory stridor is. The experts divide the differential diagnosis into intrinsic and extrinsic categories. Dr. Cotton lists tracheomalacia, complete tracheal rings and masses, such as an isolated hemangioma or granuloma. The usual extrinsic lesion is a vascular anomaly, the most common being an innominate artery. Dr. Crysdale's differential diagnosis includes tracheal stenosis, either congenital or acquired, and tracheomalacia. Vascular compression is most common as an extrinsic cause. Dr. Parsons includes tracheomalacia, complete tracheal rings, segmental tracheal stenosis, isolated masses, and vascular anomalies, such as an aberrant innominate artery. He also states that a tracheoesophageal fistula must be considered. Dr. Cotton prefers MRI and possibly a barium swallow for assessing vascular architecture. Even finding an air bronchogram on a chest x-ray can pinpoint an area of stenosis. The best test is direct laryngoscopy with video-photography. While Drs. Parsons and Crysdale agree that direct laryngoscopy is the best, Dr. Crysdale also suggests MRI or CT and adds that a contrast bronchogram is a most useful test.(ABSTRACT TRUNCATED AT 250 WORDS)