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Vascular compression of the airway: establishing a functional diagnostic algorithm
Derek J Rogers1, Mary Beth Cunnane, Christopher J Hartnick
1Departments of Pediatric Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA 02114, USA.
JAMA Otolaryngology-- Head & Neck Surgery
|June 22, 2013
Summary
Computed tomography with angiography (CTA) identified vascular anomalies in 50% of pediatric patients with airway symptoms. Half of these required surgery, highlighting the need for a diagnostic algorithm to balance imaging risks with clinical benefits.
Area of Science:
- Pediatric radiology
- Thoracic surgery
- Vascular anomalies
Background:
- Pediatric imaging, including computed tomography with angiography (CTA), carries radiation exposure risks.
- Children often undergo CTA after bronchoscopy for airway symptoms, but the necessity of this imaging is not always clear.
Purpose of the Study:
- To evaluate the utility of CTA in pediatric patients with airway symptoms following bronchoscopy.
- To determine the rate of positive CTA findings leading to surgery.
- To propose a diagnostic algorithm balancing imaging risks with clinical benefits.
Main Methods:
- Retrospective review of 42 pediatric patients (2 months to 11 years) with tracheomalacia who underwent CTA.
- Data collected included bronchoscopy findings, CTA results, and need for thoracic surgery.
Main Results:
- 50% of patients had a vascular anomaly detected by CTA.
- Innominate artery compression was the most common anomaly (81% of positive cases).
- 29% of patients with vascular anomalies required thoracic surgery due to symptoms like cough, cyanosis, and stridor.
Conclusions:
- CTA is valuable in diagnosing vascular anomalies in pediatric patients with airway symptoms.
- A diagnostic algorithm can help optimize patient care by considering radiation and sedation risks.
- Further research is needed to refine decision-making for imaging in this population.
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