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[Lateral tracheal indentation or compression by the brachiocephalic arterial trunk in children]
S Ghidalia1, J Y Cohen, M P Quéré
1Service de Radiologie Thoracique, CHRU de Nantes.
Insights
Innominate artery buckling can compress the trachea in children, often linked with aortic coarctation. Early diagnosis is crucial to prevent severe tracheomalacia and manage associated cardiovascular issues.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Thoracic Surgery
Background:
- Vascular rings and slings are rare congenital anomalies causing airway compression in infants and children.
- Compression of the trachea by the innominate artery is a specific type of vascular anomaly that can lead to significant respiratory distress.
Observation:
- This report details three pediatric cases of tracheal compression due to innominate artery buckling.
- Associated cardiovascular anomalies, including coarctation of the thoracic aorta and left cervical aortic arch, were present in all cases.
- One patient developed severe tracheomalacia post-operatively after coarctation repair.
Findings:
- Lateral tracheal indentation suggested a right aortic arch, but the absence of posterior esophageal indentation ruled out this diagnosis.
- Diagnostic angiography proved helpful, while echocardiography could not identify the vascular cause of tracheal compression.
- A high incidence of associated cardiovascular malformations was noted.
Implications:
- Accurate diagnostic strategies are essential for identifying innominate artery compression of the trachea.
- Recognizing the risk of tracheomalacia following surgical intervention is critical for patient management.
- Comprehensive evaluation for concurrent cardiovascular anomalies is recommended in affected children.
Abstract:
Three cases of compression of the right wall of the trachea by buckling of the innominate artery in childhood are described. A coarctation of the thoracic aorta is associated in two cases, and a left cervical aortic arch in the third one. In one case, a severe tracheomalacia occurs following the surgical repair of the associated coarctation. This lateral indentation of the trachea is suggestive of right aortic arch but the absence of posterior oesophageal indentation excludes the diagnosis. Angiography is helpful and echography is unable to demonstrate the vascular origin of the tracheal compression. The authors analyse the correct diagnostic approach, emphasize the risk of tracheomalacia and the high rate of associated cardio-vascular malformations.