Innominate Artery Compression of the Trachea: An Unusual Cause of Apnea in a 12-Year-Old Boy

Abstract

Innominate artery compression of the trachea is a common cause of airway obstruction in infants and young children. The clinical significance of this lesion, even when compression is documented endoscopically or radiographically, is controversial. Obstructive respiratory symptoms occur in only a fraction of such cases, and symptomatic patients are most commonly detected in the first year of life. We present a case of a 12-year-old boy with a chief complaint of progressive stridor and apnea who was diagnosed with symptomatic innominate artery compression of the trachea. We reviewed the literature regarding the pathology, diagnosis, and treatment of this condition.

Mild tracheal compression by aberrant innominate artery and chronic dry cough in children

“…[5][6][7][8]10,27,31 However, as shown by the present study and by other reports, 8,24,[29][30][31][32][33] this syndrome may be detected also in older children, a later diagnosis being related to less severe symptoms and, possibly, to a lower degree of TC. 3,8,29,34 How can a mild TC be involved in the pathogenesis of cough? Firstly, in a significant proportion of children with mild compression on CT scans, the degree of tracheal narrowing in expiration or following cough was significantly greater during bronchoscopy due to concomitant tracheomalacia.…”

“…This congenital malformation is thought to be related to “mediastinal crowding” and, by three years of age, the aortic arch growth causes the innominate artery to move cephalad, anteriorly, and to the right, away from the trachea. Other factors, including thymic involution, growth of rib cage, and of the supportive tracheal cartilages may also explain the decreased incidence of TC with advancing age . Other anatomic anomalies, such as primary tracheomalacia, can be important causative factors of this condition .…”

“…8,[29][30][31] Other anatomic anomalies, such as primary tracheomalacia, can be important causative factors of this condition. [5][6][7][8]10,27,31 However, as shown by the present study and by other reports, 8,24,[29][30][31][32][33] this syndrome may be detected also in older children, a later diagnosis being related to less severe symptoms and, possibly, to a lower degree of TC. 3,8,29,34 How can a mild TC be involved in the pathogenesis of cough?…”

Obstructive airway in Morquio A syndrome, the past, the present and the future

“…The syndrome of brachiocephalic artery compression of the trachea was first reported in 1948 (23, 24, 25). Brachiocephalic artery compression of the trachea represents the most common cause of narrowed airway.…”

Airway Obstruction Due to Tracheomalacia Caused by Innominate Artery Compression and a Kyphotic Cervical Spine

“…The majority of patients with innominate artery compression of the trachea are successfully treated with medical management, which generally includes humidified oxygen, steroids, and antibiotics, as required [7]. Innominate artery reimplantation is a safe and effective treatment for innominate artery compression syndrome [4].…”