Multi-slice computed tomography assessment of bronchial compression with absent pulmonary valve.
BACKGROUND
Absent pulmonary valve is a rare cardiovascular anomaly that can result in profound tracheobronchial compression.


OBJECTIVE
To demonstrate the advantage of multi-slice CT in diagnosing tracheobronchial compression, its severity as related to the adjacent dilated pulmonary arteries, and associated lung and cardiac lesions.


METHODS
We included children with absent pulmonary valve who were reviewed by multi-slice CT during a 17-year period. The number and locations of stenoses and lung lesions were noted and the severity of stenosis was categorized. The diameter of the pulmonary artery was measured and associated cardiac defects were demonstrated.


RESULTS
Thirty-one children (14 girls and 17 boys) were included. Of these, 29 had ventricular septal defect and 2 had an intact ventricular septum. Twenty-nine children (94%) had tracheobronchial compression, judged to be mild in nine children (31%), moderate in 10 (34%) and severe in 10 (34%). The different locations of the stenosis (carina, main bronchi, lobar and segmental bronchi) were observed. And the number and location of lung lesions demonstrated that the right middle and left upper and lower lobes were often affected. The diameter of the pulmonary artery in these children was well above normal published values, and Spearman rank correlation analysis showed a correlation between the size of the pulmonary artery and the severity of the tracheobronchial stenosis. Nineteen children (61%) underwent surgery and 4 of these children had a multi-slice CT post-operative follow-up study.


CONCLUSIONS
Absent pulmonary valve can cause significant morbidity and mortality in children. Multi-slice CT can accurately depict areas of tracheobronchial compression, associated lung lesions and cardiac defects, helping to direct the surgeon.
Department of Radiology, Shanghai Children's Medical Center and Shanghai Jiao Tong University Medical School, Shanghai, China.
Yu-Min
YM
Zhong
Richard B
RB
Jaffe
Jin-Fen
JF
Liu
Ai-Min
AM
Sun
Wei
W
Gao
Qian
Q
Wang
Ming
M
Zhu
Hai-Sheng
HS
Qiu
Walter E
WE
Berdon
D001982:Bronchial Diseases / Q000000981:diagnostic imaging* / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging / Q000209:etiology; D005260:Female; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D061330:Multidetector Computed Tomography; D011651:Pulmonary Artery / Q000000981:diagnostic imaging; D011664:Pulmonary Valve / Q000002:abnormalities*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014135:Tracheal Stenosis / Q000000981:diagnostic imaging* / Q000209:etiology