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[Vascular tracheal compression presenting as bronchiolitis in infants]
V Flurin1, A Deschildre, C Fourier
1Service de réanimation ìnfantile, hôpital Calmette, Lille, France.
Insights
Vascular anomalies compressing the trachea can cause chronic stridor or wheezing in infants. Early investigation is crucial for diagnosing and treating these serious airway conditions.
Area of Science:
- Pediatric Pulmonology
- Congenital Cardiovascular Surgery
Background:
- Anomalies of the aortic arch and pulmonary arteries can lead to tracheal compression.
- Symptoms include chronic stridor or wheezing, exacerbated by feeding or neck flexion.
Observation:
- Three infants presented with acute bronchiolitis and underlying airway issues.
- Case 1: Pulmonary artery sling with tracheal stenosis, treated surgically.
- Case 2: Pulmonary artery sling causing tracheal stenosis and atelectasis.
- Case 3: Double aortic arch leading to tracheal stenosis and respiratory distress.
Findings:
- Tracheal stenosis due to vascular anomalies is a critical diagnosis in infants with respiratory symptoms.
- Diagnostic tools include X-rays, CT scans, and bronchoscopy.
- Surgical correction of vascular anomalies improved patient outcomes.
Implications:
- Consider vascular compression of the trachea in infants with stridor/wheezing, especially when admitted for bronchiolitis.
- Prompt investigation with appropriate imaging and bronchoscopy is essential.
- Timely surgical intervention can resolve airway obstruction and improve prognosis.
Background:
Anomalies of the aortic arch and pulmonary arteries may produce compression of the trachea with chronic stridor or wheezing aggravated by crying, feeding and flexion of the neck.
Case Reports:
Three infants, 3, 5 and 2 months-old, respectively, were admitted suffering from acute bronchiolitis. The first patient had intermittent wheezing for one month; lateral chest X-rays showed an opaque area inserted between the trachea and oesophagus and computed tomography showed pulmonary artery sling with tracheal stenosis which was successfully operated. The second patient displayed pulmonary atelectasia which required bronchoscopy; this technique showed tracheal stenosis which was due to pulmonary artery sling. The third patient had a history of congenital stridor: he required endotracheal intubation; a bronchoscopy performed because persistent pulmonary atelectasia showed tracheal stenosis which was secondary to a double aortic arch. The condition was improved after surgical correction.
Conclusions:
A history of stridor and/or wheezing in patients admitted for bronchiolitis must lead to consider the possibility of vascular compression of the trachea and to perform specific investigations.