title: Vascular compression of the airway: establishing a functional diagnostic algorithm.
abstract: OBJECTIVE
  Pediatric imaging carries the risk of radiation exposure. Children frequently undergo computed tomography with angiography (CTA) for findings on bronchoscopy with limited knowledge regarding the necessity of such imaging.
  
  
  OBJECTIVE
  To report our experience with all pediatric patients at our institution over an 8-year period with airway symptoms warranting bronchoscopy followed by CTA for potential vascular anomaly. Goals were to report the percentage of positive findings seen on CTA leading to surgery; discuss relative radiation exposure risk and sedation risk for additional radiologic studies; and propose a functional diagnostic algorithm.
  
  
  METHODS
  Retrospective chart review of 42 children aged 2 months to 11 years with tracheomalacia who underwent CTA between 2004 and 2012 in our tertiary aerodigestive center.
  
  
  METHODS
  Bronchoscopy and CTA.
  
  
  METHODS
  Presence of vascular anomaly and need for thoracic surgery.
  
  
  RESULTS
  Of these 42 children, 21 (50%) had a vascular anomaly identified on CTA. Of these 21, 17 (81%) had innominate artery compression; 1 (5%) had double aortic arch; 1 (5%) had right aortic arch; 3 (14%) had bronchial compression by pulmonary artery; and 1 (5%) had dextrocardia with duplicated vena cava. Six (29%) of these 21 had clinical symptoms and CTA findings requiring thoracic surgery. The most common symptoms in children requiring thoracic surgery were cough, cyanosis, and stridor.
  
  
  CONCLUSIONS
  Deciding when to obtain imaging for bronchoscopic findings suggestive of vascular compression remains challenging. A diagnostic algorithm is proposed as a means to provide the best clinical care while weighing risks of additional radiation exposure vs sedation and exposure to general anesthesia.
authors.affiliation: Departments of Pediatric Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA 02114, USA.
authors.forename: Derek J
authors.initials: DJ
authors.lastname: Rogers
authors.forename: Mary Beth
authors.initials: MB
authors.lastname: Cunnane
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Hartnick
mesh_terms: D000465:Algorithms; D000792:Angiography; D001999:Bronchoscopy; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D055090:Tracheomalacia / Q000175:diagnosis* / Q000209:etiology* / Q000601:surgery; D054079:Vascular Malformations / Q000150:complications* / Q000175:diagnosis* / Q000601:surgery