Tracheal compression by the innominate artery in infancy and childhood

Area of Science:

• Pediatric Radiology
• Vascular Anatomy
• Congenital Heart Disease

Background:

• The innominate (brachiocephalic) artery's normal radiographic anatomy in children is crucial for diagnosing various conditions.
• Anterior tracheal indentation is a potential radiographic finding that requires anatomical correlation.

Purpose of the Study:

• To evaluate the normal radiographic anatomy of the innominate artery in pediatric patients.
• To determine the incidence of anterior tracheal indentation caused by the innominate artery in children under two years old.
• To describe the typical origin and course of the innominate artery relative to the trachea.

Main Methods:

• Review of 1,000 randomly selected lateral chest radiographs in children.
• Analysis of 172 angiograms in children diagnosed with congenital heart disease.

Main Results:

• Anterior tracheal indentation was observed in 30% of children under 2 years of age on lateral chest radiographs.
• Angiographic findings confirmed that the innominate artery typically originates left of the trachea and crosses anteriorly.
• This anatomical course is considered normal and can explain the observed tracheal indentation.

Conclusions:

• The innominate artery's anterior crossing over the trachea is a normal anatomical variant in children.
• Radiologists should be aware of this normal anatomy to avoid misinterpreting tracheal indentation as pathology.
• Understanding the innominate artery's typical course aids in the accurate diagnosis of pediatric airway and cardiovascular conditions.