Multi-slice computed tomography assessment of bronchial compression with absent pulmonary valve

Abstract

BackgroundAbsent pulmonary valve is a rare cardiovascular anomaly that can result in profound tracheobronchial compression.ObjectiveTo 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.Materials and methodsWe 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.ResultsThirty-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.ConclusionAbsent 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.

Noninvasive Imaging Study of Tracheobronchial Compression Caused By Tortuosity and Dilation of the Thoracic Artery

“…Cardiovascular structures and airway anatomy are closely related; thus, tracheobronchial compression often occurs in some cardiovascular abnormalities, and could lead to recurrent respiratory infection, shortness of breath and wheezing [1][2][3][4]. Tracheobronchial compression can also be caused by certain rare vascular anomalies.…”

“…Bronchomalacia can occur from prolonged bronchial compression and tracheobronchial cartilage immaturity Five (5/6) had mild compression located at the upper one third of trachea, one (1/6) had severe compression located at the upper two thirds of trachea, three (3/6) had mild compression located at the lower one third of trachea and three (3/6) had mild left main bronchial compression. before the first 6-9 months of age, so, aggressive management as early as possible is needed for a favorable prognosis [4,[18][19][20]. And cine and volume helical shuttle(VHS) computed tomography (CT) , and spirometer-controlled cine magnetic resonance imaging(MRI ) are all good techniques for evaluation for tracheobronchomalacia [21] though it is a pity that in this study no special techniques for evaluation for tracheobronchomalacia, and we will evaluate tracheobronchomalacia for posterior and the follow up study.…”

“…Cardiovascular structures and airway anatomy are closely related; thus, tracheobronchial compression often occurs in some cardiovascular abnormalities, such as vascular rings, left pulmonary artery sling, and absent pulmonary valve, and could lead to recurrent respiratory infection, shortness of breath and wheezing [1][2][3][4]. It is founded that tracheobronchial compression can also be caused by certain rare vascular anomalies, such as tortuosity, dilation and aneurysm formation in large and medium-sized thoracic arteries, which are found in some rare connective tissue disorders such as arterial tortuosity syndrome (ATS), Loeys-Dietz syndrome (LDS) and Marfan syndrome (MFS) [5][6][7][8][9][10][11].…”

Computed Tomography Imaging in Patients with Congenital Heart Disease Part I: Rationale and Utility. An Expert Consensus Document of the Society of Cardiovascular Computed Tomography (SCCT)

“…This dilation may causes bronchial compression, which is well visualized by cardiovascular CT as is any associated air trapping. 164 After complete repair of TOF, patients with residual pulmonary regurgitation often develop right ventricular dilation and dysfunction. Furthermore, during adulthood 20% of patients with repaired TOF develop left ventricular systolic dysfunction which may improve after pulmonary valve replacement.…”

Pediatric Cardiothoracic CT Guideline Provided by the Asian Society of Cardiovascular Imaging Congenital Heart Disease Study Group: Part 2. Contemporary Clinical Applications

“…In absent pulmonary valve syndrome, CT is useful for assessing vascular bronchial compressions due to markedly dilated pulmonary arteries before and after surgical treatment ( Fig. 4 ) [ 21 ].…”