Related Experiment Videos
Tracheal compression and the innominate artery: MR evaluation in infants
1Department of Radiology, University Hospitals of Cleveland.
Insights
Magnetic resonance (MR) imaging can noninvasively assess infant tracheal compression. Findings suggest symptoms stem from tracheal cartilage weakness, not innominate artery position.
Area of Science:
- Pediatric Radiology
- Thoracic Imaging
- Diagnostic Medicine
Background:
- Infants with airway symptoms often require evaluation for tracheal compression.
- The innominate artery is a potential cause of extrinsic tracheal compression in children.
- Noninvasive imaging is crucial for diagnosing mediastinal abnormalities.
Purpose of the Study:
- To evaluate the utility of Magnetic Resonance (MR) imaging in diagnosing tracheal compression by the innominate artery in infants.
- To correlate MR findings with endoscopic evaluations in pediatric patients.
- To investigate the anatomical basis of tracheal compression in infants.
Main Methods:
- Seventeen infants and children (3-29 months) with obstructive airway symptoms underwent MR imaging.
- Flexible fiberoptic tracheobronchoscopy was performed for comparison.
- Anatomical relationships and mediastinal dimensions were analyzed on MR images.
Main Results:
- MR imaging and endoscopy showed high correlation in diagnosing tracheal compression.
- Eight patients had MR and endoscopic evidence of innominate artery-related tracheal compression; eight did not.
- No significant differences in innominate artery position or mediastinal dimensions were found between groups.
- Follow-up showed decreasing compression without altered tracheal-arterial relationships.
Conclusions:
- Anomalous innominate artery position is unlikely to cause anterior tracheal compression.
- Symptoms of tracheal compression in infants may be attributed to intrinsic tracheal cartilage deficiency.
- MR imaging is a valuable noninvasive tool for evaluating pediatric tracheal compression.
Abstract:
Magnetic resonance (MR) imaging offers a noninvasive method of evaluating the mediastinum in infants with suspected compression of the trachea by the innominate artery. MR imaging was performed in 17 infants and children, aged 3-29 months, who had obstructive airway symptoms and who had undergone flexible fiberoptic tracheobronchoscopy. MR and endoscopic findings correlated in all cases but one. Of the remaining 16 patients, eight had endoscopic and MR evidence of tracheal compression at the level of the innominate artery, and eight had a normal upper thoracic trachea. In both groups, the innominate artery was situated anterior and to the left of the trachea with no difference in anatomic relationships. Measurements of the anteroposterior and transverse dimensions of the upper part of the mediastinum and the thymus failed to disclose significant differences between the two groups. Follow-up examinations of three patients showed decreasing tracheal compression without changes in tracheal-arterial relationships. This investigation disclosed no evidence of excessive mediastinal crowding. The findings support previous angiographic observations indicating that anterior tracheal compression is not due to an anomalous position of the innominate artery. Symptoms of tracheal compression may result from an intrinsic deficiency of the tracheal cartilage rather than an anatomic abnormality of the mediastinum or its vasculature.