title: MDCT evaluation of the prevalence of tracheomalacia in children with mediastinal aortic vascular anomalies.
abstract: OBJECTIVE
  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).
  
  
  METHODS
  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).
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Radiology and Medicine, Pulmonary Division, Children's Hospital Boston, Harvard Medical School, Boston, MA 02115, USA. Edward.Lee@childrens.harvard.edu
authors.forename: Edward Y
authors.initials: EY
authors.lastname: Lee
authors.forename: David
authors.initials: D
authors.lastname: Zurakowski
authors.forename: David A
authors.initials: DA
authors.lastname: Waltz
authors.forename: Keira P
authors.initials: KP
authors.lastname: Mason
authors.forename: Farhana
authors.initials: F
authors.lastname: Riaz
authors.forename: Amy
authors.initials: A
authors.lastname: Ralph
authors.forename: Phillip M
authors.initials: PM
authors.lastname: Boiselle
mesh_terms: D000293:Adolescent; D001999:Bronchoscopy; D002648:Child; D002675:Child, Preschool; D003287:Contrast Media; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008482:Mediastinum / Q000098:blood supply* / Q000000981:diagnostic imaging*; D015995:Prevalence; D011857:Radiographic Image Interpretation, Computer-Assisted; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*; D055090:Tracheomalacia / Q000000981:diagnostic imaging* / Q000453:epidemiology; D054079:Vascular Malformations / Q000000981:diagnostic imaging* / Q000453:epidemiology
chemical_list: D003287:Contrast Media