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The position of the trachea in infants and children with right aortic arch
J L Strife1, J Matsumoto, G S Bisset
1Department of Radiology, Children's Hospital Medical Center, Cincinnati, Ohio.
Insights
In infants with a right aortic arch, tracheal position on chest radiographs is variable and unreliable for determining aortic arch location. Caution is advised when inferring aortic arch situs from tracheal position in this population.
Area of Science:
- Pediatric Cardiology
- Diagnostic Imaging
- Thoracic Radiology
Background:
- The position of the intrathoracic trachea is often used to infer the site of the aortic arch in infants.
- Congenital heart disease, particularly cyanotic types, can be associated with aortic arch anomalies.
Purpose of the Study:
- To evaluate the reliability of tracheal position in predicting the site of the aortic arch in infants with a right aortic arch.
- To determine the variability of tracheal position in infants diagnosed with a right aortic arch.
Main Methods:
- Retrospective review of plain frontal chest radiographs.
- Analysis of 72 infants with cyanotic congenital heart disease and a documented right aortic arch via cardiac catheterization.
Main Results:
- Tracheal position was variable in infants with a right aortic arch: 47% were on the right, 33% midline, and 7% on the left.
- Tracheal indentation by the aortic arch and visualization of the descending aorta improve with age.
Conclusions:
- Tracheal position in infants with a right aortic arch is not a consistently reliable indicator of aortic arch situs.
- Radiologists and clinicians should exercise caution when using tracheal position to infer aortic arch location in infants with right aortic arch.
Abstract:
In infants, the site of the aortic arch is frequently inferred from the position of the intrathoracic trachea. We retrospectively reviewed the plain frontal chest radiographs of 72 patients with cyanotic congenital heart disease and right aortic arch documented by cardiac catheterization. In infants, the position of the trachea was variable: 47% had the trachea on the right, 33% had the trachea midline and in 7% the trachea was on the left. As the child grows, the aortic arch progressively indents the trachea, and the descending aorta is better visualized. Since the position of the trachea in infants with right aortic arch is variable, one must be cautious in inferring the site of the aortic arch by the position of the trachea.