Anurag Yadav*, TBS Buxi, Supraja Reddy, Samarjit Singh Ghuman, Kishan Singh Rawat, Savitha Srirama Jayamma
Department of CT and MRI, Sir Ganga Ram Hospital, New Delhi, -110060, India
Received:09 October, 2015;Accepted: 18 November, 2015; Published: 20 November, 2015
Anurag Yadav, MBBS, DNB, Sir Ganga Ram Hospital, Old Rajinder Nagar, New Delhi – 110060, India, Fax: 011-42437440; Tel: +918800836830; E-mail:
Yadav A, Buxi TBS, Reddy S, Ghuman SS, Rawat KS, et al. (2015) Clinico-Radiological Correlation in 7 Cases of Airway Compression by Vascular Anomalies on MDCT. Global J Med Clin Case Reports 2(1): 017-022. DOI: 10.17352/2455-5282.000020
© 2015 Yadav A, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Vascular rings; Pulmonary slings; Airway compression; Congenital heart disease; Multi-detector computed tomography
Compression of the airway by vascular anomalies is a co-morbidity occurring frequently in children with congenital heart diseases. Here we presented a cohort of 7 patients with respiratory distress who showed airway compression due to vascular anomalies on evaluated with multidetector computed tompgraphy. The anomalies detected were double aortic arch, left sided aortic arch with aberrant right subclavian artery, right sided aortic arch with aberrant left subclavian artery, left pulmonary artery forming a pulmonary sling and dilated right pulmonary artery compressing the right main bronchus.
• Airway compression causes morbidity in children with congenital heart diseases.
• Aortic and pulmonary vessel anomalies are the main causes of airway compression.
• MDCT can delineate the vascular anatomy and the severity of resultant airway compression.
Airway compression by vascular structures is a co-morbidity occurring in approximately 1–2% of children with congenital heart diseases (CHD) . In children, airway compression by vascular structures is usually caused either by anomalous configuration of the great vessels or enlargement of normally formed vascular structures . The common congenital vascular anomalies associated with compression of airway are vascular rings and slings. The term vascular ring refers to an encirclement of the trachea by a combination of derivatives of the aortic arches . Pulmonary sling is commonly caused by an anomalous or aberrant left pulmonary artery. They encircle and/or compress the trachea and produce symptoms like respiratory distress, recurrent pneumonia . Multi-detector computed tomography (MDCT) can delineate the vascular anatomy and degree of airway compression accurately due to the advancements like multi-planar reconstructions and post processing techniques like volume rendering, shaded surface display and minimum intensity projection.
Materials and Methods
This study presents a series of seven patients diagnosed with airway compression due to vascular anomalies out of 100 patients of CHD studied in our department over a three year period (2011-2014).
CT Angiography (CTA) of thorax was performed on Phillips Ingenuity 128 slice scanner. After pre-anesthetic check-up, the patients were scanned in supine position under sedation. Midazolam 0.1 mg/kg body weight was used for sedation. Non-contrast sections were obtained, followed by injection of intra-venous contrast at a dose of 2 ml/kg body weight, at the rate of 2.5 ml per second at a pressure of 150 to 175 psi followed by 5ml saline flush using a dual head medrad pressure injector. The contrast used was iodixanol 270 mg/ml. Using bolus tracking method, arterial phase images were acquired when pulmonary attenuation crossed 120HU and venous phase following a delay of 20 seconds.
Out of 100 patients with CHD, airway compression due to vascular anomalies was seen in 7 patients, which implies 7% of CHD had airway compression due to vascular anomalies. Out of these seven cases, six patients were females and one was a male. All the patients presented with respiratory distress and cyanosis except for one patient who presented with palpitation. Five patients had tracheal compression in whom mid and lower third was affected equally and upper third was affected by the innominate artery. None of these patients had grade IV compression. Bronchial compression was seen in three patients and all the patients had grade IV compression. In two patients, tracheal compression was due to double aortic arch, one of them had hypoplastic right arch and the other had two arches of same caliber. Two patients had tracheal compression due to aberrant subclavian artery, one of them with a left aortic arch and retroesophageal right subclavian artery and the other with a right aortic arch and retroesophageal left subclavian artery. Two patients showed compression of right main bronchus due to dilated right pulmonary artery. One patient showed compression of left main bronchus due to sling formed by left pulmonary artery. In this patient, there was also evidence of tracheal compression due to innominate artery (Figures 1-7, Table 1).