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Upper airway obstruction caused by vascular anomalies in children
1Department of Pediatrics, National Cheng Kung University Hospital, Tainan, Taiwan, R.O.C.
Insights
Vascular rings and slings are key causes of congenital upper airway obstruction in children. Early diagnosis via esophagogram and echocardiogram aids in identifying these anomalies and guiding treatment for stridor.
Area of Science:
- Pediatric Surgery
- Cardiology
- Radiology
Background:
- Congenital vascular anomalies can cause pediatric upper airway obstruction.
- Stridor is a common symptom requiring thorough etiological investigation.
Purpose of the Study:
- To evaluate the diagnostic utility of esophagogram and echocardiography in children with stridor.
- To identify the types and prevalence of vascular anomalies causing congenital upper airway obstruction.
Main Methods:
- Retrospective review of 92 children with stridor evaluated between 1988 and 1995.
- Initial diagnostic tools included esophagogram and two-dimensional echocardiography.
- Surgical intervention was performed for severe respiratory distress.
Main Results:
- Seven children (7.7%) were diagnosed with vascular anomalies causing airway compression.
- Common anomalies included pulmonary artery sling and double aortic arch.
- Five patients were initially misdiagnosed with laryngomalacia; six showed esophageal indentation.
Conclusions:
- Esophagogram and echocardiography are valuable for diagnosing vascular ring/sling in children with stridor.
- Vascular anomalies should be considered in the differential diagnosis of congenital stridor, even with prior misdiagnosis.
- Surgical management can improve symptoms, but complications like intrinsic tracheal stenosis require careful attention.
Abstract:
Vascular ring or sling is one of the important etiologies for congenital upper airway obstruction in children. Between July 1988 and July 1995, a total of 92 children with stridor were initially evaluated by an esophagogram and two-dimensional echocardiogram. Seven children (7.7%) with variable types of vascular anomalies were diagnosed including pulmonary artery sling (2 cases), double aortic arch (1 case), right arch with left aberrant subclavian artery and ligamentum ductus (1 case), double aortic arch with one atretic arch (2 cases), and innominate artery compression of the trachea (1 case). The age at diagnosis ranged from 18 days to 3 years old. Only one patient was associated with an intracardiac anomaly. Five of the 7 patients were diagnosed as having laryngomalacia previously. Six patients had esophageal indentation on their esophagograms. Besides external airway compression, three patients also had intrinsic tracheal stenosis. Six patients received surgery because of severe respiratory distress. The patients' symptoms improved after surgery, but a premature baby died after a second operation for intrinsic tracheal stenosis at the age of 8 months.