Bronchoscopy versus multi-detector computed tomography in the diagnosis of congenital vascular ring

Vascular rings are congenital vascular anomalies of the aortic arch complex which cause compression of the trachea and/or oesophagus. A variety of investigations may lead to diagnosis of these anomalies, including bronchoscopy and computed tomography. During the latter, image acquisition and processing use the multi-detector row technique and new reconstruction algorithms, producing high-resolution images which can be visualised as complex, three-dimensional renditions.

This study aimed to assess and compare the roles of bronchoscopy and multi-detector row computed tomography in the diagnosis of congenital vascular ring.

We included infants and children below the age of 16 years who presented with congenital vascular ring. All patients underwent rigid bronchoscopy under general anaesthesia, with spontaneous respiration. All computed tomography scans were obtained using a 16 multi-detector row computed tomography system, followed by data reconstruction on a three-dimensional workstation.

Ten patients with congenital vascular ring were identified (six boys and four girls). Fifty per cent of cases presented within the first year of life. Double aortic arch was the most common anomaly (40 per cent). Bronchoscopy detected external tracheal compression in nine cases (90 per cent). Associated airway lesions were detected endoscopically in three cases. In contrast, multi-detector row computed tomography detected the vascular ring in all cases, with accurate detection of the compressing vessel; however, it did not detect any associated airway lesions.

Bronchoscopy and radiological evaluation are essential for the diagnosis and pre-operative evaluation of congenital vascular ring. Multi-detector row computed tomography can provide more information about the nature of the disease, and can facilitate better communication between clinicians, compared with conventional computed tomography.