Lee Edward Y, Zurakowski David, Waltz David A, Mason Keira P, Riaz Farhana, Ralph Amy, Boiselle Phillip M
Department of Radiology and Medicine, Pulmonary Division, Children's Hospital Boston, Harvard Medical School, Boston, MA 02115, USA.
J Thorac Imaging. 2008 Nov;23(4):258-65. doi: 10.1097/RTI.0b013e31817fbdf7.
The purpose of this study is to determine the prevalence of tracheomalacia (TM) associated with different types of mediastinal aortic vascular anomalies in symptomatic children using paired inspiratory-expiratory multidetector computed tomography (MDCT).
The study group consisted of 15 consecutive symptomatic pediatric patients (12 males/3 females; mean age of 4.4 y; age range of 2 wk to 16 y) with mediastinal aortic vascular anomalies, who were referred for paired inspiratory-expiratory MDCT during a 35-month time period. Computed tomography (CT) angiography was also concurrently performed during the end-inspiration phase of the study. Two radiologists in consensus reviewed all CT images in a randomized and blinded fashion. End-inspiration and end-expiration CT images were reviewed for the presence and severity of tracheal narrowing and the type of mediastinal aortic vascular anomaly involved. TM was defined as > or =50% reduction in tracheal cross-sectional luminal area between end-inspiration and end-expiration. The presence of TM was correlated with the type of mediastinal aortic vascular anomaly and compared with the bronchoscopy results when available (n=9).
Mediastinal aortic vascular anomalies included innominate artery compression (IAC) (n=6), a right aortic arch with an aberrant left subclavian artery (n=5), double aortic arch (n=3), and a left aortic arch with an aberrant right subclavian artery (n=1). Eight of 15 (53.3%) patients demonstrated TM. TM was seen in all 6 patients (100%) with IAC, 1 of 3 (33.3%) patients with double aortic arch, and 1 of 5 (20%) patients with a right aortic arch with an aberrant left subclavian artery. CT results were concordant with the results of bronchoscopy in all patients who underwent this procedure (n=9).
Symptomatic pediatric patients with mediastinal aortic vascular anomalies have a relatively high prevalence of TM, especially those with IAC. Paired inspiratory-expiratory MDCT should be considered part of the routine preoperative evaluation of TM in symptomatic children with IAC and also has the potential to play a role in evaluating patients with other mediastinal aortic vascular anomalies.
本研究旨在通过配对吸气-呼气多层螺旋计算机断层扫描（MDCT）确定有症状儿童中与不同类型纵隔主动脉血管异常相关的气管软化（TM）的患病率。
研究组由15例连续的有症状儿科患者（12例男性/3例女性；平均年龄4.4岁；年龄范围2周龄至16岁）组成，这些患者患有纵隔主动脉血管异常，在35个月的时间段内被转诊进行配对吸气-呼气MDCT检查。在研究的吸气末阶段同时进行计算机断层扫描（CT）血管造影。两位放射科医生以随机和盲法的方式共同审查所有CT图像。对吸气末和呼气末CT图像进行审查，以确定气管狭窄的存在和严重程度以及所涉及的纵隔主动脉血管异常的类型。TM定义为吸气末至呼气末气管横截面积减少≥50%。TM的存在与纵隔主动脉血管异常的类型相关，并与可用时的支气管镜检查结果（n = 9）进行比较。
纵隔主动脉血管异常包括无名动脉压迫（IAC）（n = 6）、右位主动脉弓伴左锁骨下动脉异常（n = 5）、双主动脉弓（n = 3）和左位主动脉弓伴右锁骨下动脉异常（n = 1）。15例患者中有8例（53.3%）表现为TM。在所有6例（100%）IAC患者、3例双主动脉弓患者中的1例（33.3%）以及5例右位主动脉弓伴左锁骨下动脉异常患者中的1例（20%）中发现了TM。在所有接受该检查的患者（n = 9）中，CT结果与支气管镜检查结果一致。
有症状的患有纵隔主动脉血管异常的儿科患者TM患病率相对较高，尤其是那些患有IAC的患者。配对吸气-呼气MDCT应被视为有症状IAC儿童TM常规术前评估的一部分，并且在评估其他纵隔主动脉血管异常患者方面也有发挥作用的潜力。
