Traxer O, de Lagausie P, Kron C, Belarbi N, Aigrain Y
Service de Chirurgie Infantile, Hôpital Robert-Debré, Paris, France.
Arch Pediatr. 1998 Apr;5(4):409-13. doi: 10.1016/s0929-693x(98)80029-8.
Abnormalities of the aortic arch which are responsible for tracheobronchial compression are well known. This case demonstrates the value of magnetic resonance imaging (MRI) for diagnosis and suggests that recurrent respiratory symptoms should evoke these abnormalities in infancy.
The authors report a very rare malformation of the aortic arch formed by encircling aortic arch, with left aortic arch, right descending aorta and right ligamentum arteriosum. It was revealed by airway disorders due to the compression of tracheobronchial axis by the ligamentum arteriosum. Section of the ligamentum permitted suppression of obstruction. The diagnosis of these abnormalities is usually established by means of oesophagogram, tracheobronchial endoscopy, angiography and MRI.
In this case, MRI gave a better picture than angiography. Sections of the ligamentum arteriosum are sometimes ineffective when compression is due to the aorta itself. Aortic uncrossing, a more complex operation, is then necessary.
导致气管支气管受压的主动脉弓异常情况是众所周知的。本病例展示了磁共振成像(MRI)在诊断中的价值,并表明反复出现的呼吸道症状在婴儿期应引发对这些异常情况的关注。
作者报告了一种非常罕见的主动脉弓畸形,由环绕型主动脉弓构成,伴有左主动脉弓、右降主动脉和右动脉韧带。它因动脉韧带压迫气管支气管轴导致气道紊乱而被发现。切断韧带可缓解梗阻。这些异常情况的诊断通常通过食管造影、气管支气管内镜检查、血管造影和MRI来确立。
在本病例中,MRI提供的图像比血管造影更好。当压迫是由主动脉本身引起时,切断动脉韧带有时无效。此时,需要进行更复杂的手术——主动脉解交叉术。