Dynamic Assessment of Tracheal Stenosis Due to Double Aortic Arch Using Low-Dose, 16-Slice Computed Tomography
A term newborn presented with dyspnea and stridor in the first day of life. Prenatal sonography revealed a suspected double aortic arch without tracheal compression. In the postnatal echocardiogram, vascular details were ambiguous. Respiratory analysis showed increased respiratory and airway resistance. Pre- and postoperative assessment was achieved with low-dose, respiratory-gated, 16-slice computed tomography (CT). Figure 1 displays the compression caused mainly by the right aortic arch (RAA) of the vascular ring. Data were reconstructed to dynamic images displaying the location and extent of tracheal compression throughout the complete breathing cycle (Figure 2; also see video available in the online only Data Supplement at http://www.circulationaha.org). Coronal reconstructions following ligation of the left arch show persistence of tracheal compression (Figure 3); the corresponding respiratory insufficiency necessitated aortopexy of the RAA.
Multislice CT offers the benefit of rapid assessment in patients who have respiratory instability or who are undergoing mechanical ventilation. It also depicts vasculature and airway compression despite continuous breathing and provides information on lung volumetrics, while limiting radiation exposure.
The video is available in the online-only Data Supplement at http://www.circulationaha.org.
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke’s Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.