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首页> 外文期刊>JAMA otolaryngology-- head & neck surgery >Vascular compression of the airway: Establishing a functional diagnostic algorithm
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Vascular compression of the airway: Establishing a functional diagnostic algorithm

机译：气道的血管压缩：建立功能性诊断算法

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Importance: 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. Design, Setting, and Participants: Retrospective chart review of 42 children aged 2months to 11 years with tracheomalacia who underwentCTAbetween 2004 and 2012 in our tertiary aerodigestive center. Interventions: Bronchoscopy and CTA. Main Outcomes and Measures: 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 and Relevance: 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.
机译：重要性：小儿影像检查有辐射风险。儿童经常接受计算机断层扫描和血管造影（CTA）检查，以了解有关这种成像的必要性的知识有限的支气管镜检查。目的：报告我们在本机构的所有儿科患者在8年期间的经验，这些患者的气道症状需要进行支气管镜检查，然后行CTA检查以检查潜在的血管异常。目的是报告在CTA上导致手术的阳性发现的百分比;讨论其他放射学研究的相对辐射暴露风险和镇静风险;并提出一种功能诊断算法。设计，环境和参与者：回顾性图表回顾性分析了2004年至2012年间在我们的三级航空消化中心接受CTA检查的42例2个月至11岁的气管软化症儿童。干预措施：支气管镜检查和CTA。主要结果和措施：存在血管异常和需要进行胸外科手术。结果：在这42名儿童中，有21名（50％）在CTA上发现了血管异常。在这21个中，有17个（81％）具有无名的动脉压迫; 1（5％）有双主动脉弓; 1（5％）有右主动脉弓; 3例（14％）被肺动脉压迫支气管; 1例（5％）患有右旋心室并有重复的腔静脉。这21例中有6例（29％）具有临床症状和需要胸部手术的CTA结果。在需要进行胸外科手术的儿童中，最常见的症状是咳嗽，发和喘鸣。结论和相关性：决定何时获取影像学提示支气管镜检查提示血管受压仍然具有挑战性。提出了一种诊断算法，以提供最佳的临床护理，同时权衡额外的辐射暴露，镇静作用和全身麻醉暴露的风险。

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