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Ngerncham M, Lee EY, Zurakowski D, Tracy DA, Jennings R. Tracheobronchomalacia in pediatric patients with esophageal atresia: comparison of diagnostic laryngoscopy/bronchoscopy and dynamic airway multidetector computed tomography. J Pediatr Surg 2015; 50:402-7. [PMID: 25746697 DOI: 10.1016/j.jpedsurg.2014.08.021] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 08/18/2014] [Accepted: 08/20/2014] [Indexed: 12/30/2022]
Abstract
PURPOSE Diagnostic laryngoscopy and bronchoscopy (DLB) has been the traditional preoperative diagnostic modality for evaluating presence and severity of tracheobronchomalacia (TBM), and requires anesthesia. Alternatively, multidetector computed tomography (MDCT) is potentially a noninvasive modality that provides high-resolution, 3-dimensional (3D) imaging of the thorax providing preoperative guidance for pediatric surgeons. This study compares MDCT with intraoperative DLB in the assessment of TBM in symptomatic pediatric patients with esophageal atresia (EA). METHODS Following IRB approval all pediatric patients (≤18 years) who had EA and who underwent an MDCT study as a preoperative evaluation of TBM prior to aortopexy were retrospectively reviewed. Patients with incomplete reports on intraoperative DLB or MDCT studies were excluded. Two pediatric radiologists independently evaluated all MDCT studies in a blinded fashion. On both DLB and MDCT studies, TBM was scored as present or absent in five anatomic segments: upper, middle, and lower trachea, as well as right and left main stem bronchi. Operative reports including DLB findings were reviewed and compared to findings from MDCT study using the chance corrected kappa (κ) coefficient. Diagnostic accuracy of dynamic MDCT for detecting TBM was determined by sensitivity and specificity, and interobserver agreement between two radiology reviewers was measured by the kappa statistic. RESULTS The final study population included 18 patients (8 males and 10 females) with ages ranging from 1month to 11years (median: 7 months). Their presenting clinical symptoms included apneic spells (n=15, 83%) and failure to extubate (n=3, 17%). The overall diagnostic accuracy of dynamic airway MDCT compared to DLB was 91% (82/90 possible segments for TBM) with excellent overall agreement across all 5 anatomic segments (κ=0.82, p<0.001). The agreements for upper, mid, lower trachea, and right and left trachea were 89% (κ=0.73, p<0.001), 94% (κ=0.85, p<0.001), 89% (κ=0.76, p<0.001), 94% (κ=0.82, p<0.001), and 89% (κ=0.61, p=0.005); respectively. Interobserver agreement between two radiologists was excellent (κ=0.98, 95% confidence interval: 0.94-1.00, p<0.001) with only 1 disagreement between two radiologists that was found for the left main bronchus. Fifteen (83.3%) of the patients clinically improved after the aortopexy. CONCLUSION MDCT with 3D imaging is a highly accurate and reliable preoperative noninvasive imaging modality for evaluating TBM in pediatric patients with EA providing anatomic information consistent with and complimentary to bronchoscopy.
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Affiliation(s)
- Monawat Ngerncham
- Department of Surgery, Faculty of Medicine Siriraj Hospital, 2 Wanglang Road, Bangkoknoi, Bangkok 10700, Thailand
| | - Edward Y Lee
- Departments of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - David Zurakowski
- Department of Anesthesia, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA; Department of Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Donald A Tracy
- Department of Radiology, Tufts University School of Medicine, 750 Washington Street, Boston, MA 02111, USA
| | - Russell Jennings
- Department of Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
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Tracheobronchomalacia in children: review of diagnosis and definition. Pediatr Radiol 2012; 42:906-15; quiz 1027-8. [PMID: 22426568 DOI: 10.1007/s00247-012-2367-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Revised: 01/18/2012] [Accepted: 01/23/2012] [Indexed: 10/28/2022]
Abstract
Tracheobronchomalacia is characterised by excessive airway collapsibility due to weakness of airway walls and supporting cartilage. The standard definition requires reduction in cross-sectional area of at least 50% on expiration. However, there is a paucity of information regarding the normal range of central airway collapse among children of varying ages, ethnicities and genders, with and without coexisting pulmonary disease. Consequently, the threshold for pathological collapse is considered somewhat arbitrary. Available methods for assessing the airway dynamically--bronchoscopy, radiography, cine fluoroscopy, bronchography, CT and MR--have issues with reliability, the need for intubation, radiation dose and contrast administration. In addition, there are varying means of eliciting the diagnosis. Forced expiratory manoeuvres have been employed but can exaggerate normal physiological changes. Furthermore, radiographic evidence of tracheal compression does not necessarily translate into physiological or functional significance. Given that the criteria used to make the diagnosis of tracheobronchomalacia are poorly validated, further studies with larger patient samples are required to define the threshold for pathological airway collapse.
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Ultrasound and colour Doppler in infantile subglottic haemangioma. Pediatr Radiol 2011; 41:1421-8. [PMID: 21904830 DOI: 10.1007/s00247-011-2213-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Revised: 05/10/2011] [Accepted: 05/23/2011] [Indexed: 12/19/2022]
Abstract
BACKGROUND Subglottic haemangioma causes progressive and life-threatening stridor, typically manifesting at age 2-3 months. Standard diagnosis is by laryngoscopy. Larynx sonography is rarely used but allows assessment of the presence and extension of a mass that impinges on the subglottic airway. The additional use of colour Doppler enables demonstration of the vascular nature of such masses. OBJECTIVE To compare US and endoscopic findings in infants with subglottic haemangioma and to evaluate accuracy of US and colour Doppler imaging in this diagnosis. MATERIALS AND METHODS We report eight infants with subglottic haemangioma seen in our institution over the last decade. They presented with laryngeal stridor and were all investigated with both US and endoscopy. Six infants underwent colour Doppler sonography. RESULTS US and endoscopic findings showed excellent anatomical correlation in lateral subglottic haemangioma. Colour Doppler imaging was deemed helpful in four infants. CONCLUSION Larynx sonography with complementary colour Doppler imaging was non-invasive and helpful in the diagnosis of subglottic haemangioma.
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Carden KA, Boiselle PM, Waltz DA, Ernst A. Tracheomalacia and Tracheobronchomalacia in Children and Adults. Chest 2005; 127:984-1005. [PMID: 15764786 DOI: 10.1378/chest.127.3.984] [Citation(s) in RCA: 423] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Tracheomalacia and tracheobronchomalacia are disorders that are encountered in both pediatric and adult medicine. Despite increasing recognition of these disease processes, there remains some uncertainty regarding their identification, causes, and treatment. This article is intended to be a comprehensive review of both the adult and pediatric forms of the diseases, and includes sections on the historical aspects of the disorders, and their classification, associated conditions, histopathology, and natural history. We also review the various modalities that are used for diagnosis as well as the state of the art of treatment, including airway stent placement and surgical intervention.
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Affiliation(s)
- Kelly A Carden
- Division of Pulmonary and Critical Care Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02446, USA
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Ederle JR, Heussel CP, Hast J, Fischer B, Van Beek EJR, Ley S, Thelen M, Kauczor HU. Evaluation of changes in central airway dimensions, lung area and mean lung density at paired inspiratory/expiratory high-resolution computed tomography. Eur Radiol 2003; 13:2454-61. [PMID: 12811503 DOI: 10.1007/s00330-003-1909-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2002] [Revised: 01/29/2003] [Accepted: 03/17/2003] [Indexed: 11/28/2022]
Abstract
The aim of this study was to improve the understanding of interdependencies of dynamic changes in central airway dimensions, lung area and lung density on HRCT. The HRCT scans of 156 patients obtained at full inspiratory and expiratory position were evaluated retrospectively. Patients were divided into four groups according to lung function tests: normal subjects ( n=47); obstructive ( n=74); restrictive ( n=19); or mixed ventilatory impairment ( n=16). Mean lung density (MLD) was correlated with cross-sectional area of the lung (CSA(L)), cross-sectional area of the trachea (CSA(T)) and diameter of main-stem bronchi (D(B)). The CSA(L) was correlated with CSA(T) and D(B). MLD correlated with CSA(L) in normal subjects ( r=-0.66, p<0.0001) and patients with obstructive ( r=-0.62, p<0.0001), restrictive ( r=-0.83, p<0.0001) and mixed ventilatory impairment ( r=-0.86, p<0.0001). The MLD correlated with CSA(T) in the control group ( r=-0.50, p<0.0001) and in patients with obstructive lung impairment ( r-0.27, p<0.05). In patients with normal lung function a correlation between MLD and D(B) was found ( r=-0.52, p<0.0001). CSA(L) and CSA(T) correlated in the control group ( r=0.67, p<0.0001) and in patients with obstructive lung disease ( r=0.51, p<0.0001). The CSA(L) and D(B) correlated in the control group ( r=0.42, p<0.0001) and in patients with obstructive lung disease ( r=0.24, p<0.05). Correlations for patients with restrictive and mixed lung disease were constantly lower. Dependencies between central and peripheral airway dimensions and lung parenchyma are demonstrated by HRCT. Best correlations are observed in normal subjects and patients with obstructive lung disease. Based on these findings we postulate that the dependencies are the result of air-flow and pressure patterns.
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Affiliation(s)
- J R Ederle
- Department of Radiology, University of Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany.
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Konen E, Faibel M, Hoffman C, Talmi Y, Rozenman J, Wolf M. Laryngo-Tracheal Anastomosis: Post-Operative Evaluation by Helical CT and Computerized Reformations. Clin Radiol 2002. [DOI: 10.1053/crad.2002.0946] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Sorantin E, Halmai C, Erdöhelyi B, Palágyi K, Nyúl LG, Ollé K, Geiger B, Lindbichler F, Friedrich G, Kiesler K. Spiral-CT-based assessment of tracheal stenoses using 3-D-skeletonization. IEEE TRANSACTIONS ON MEDICAL IMAGING 2002; 21:263-273. [PMID: 11989850 DOI: 10.1109/42.996344] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
PURPOSE Demonstration of a technique for three-dimensional (3-D) assessment of tracheal-stenoses, regarding site, length and degree, based on spiral computed tomography (S-CT). PATIENTS AND METHODS S-CT scanning and automated segmentation of the laryngo-tracheal tract (LTT) was followed by the extraction of the LTT medial axis using a skeletonization algorithm. Orthogonal to the medial axis the LTT 3-D cross-sectional profile was computed and presented as line charts, where degree and length was obtained. Values for both parameters were compared between 36 patients and 18 normal controls separately. Accuracy and precision was derived from 17 phantom studies. RESULTS Average degree and length of tracheal stenoses was found to be 60.5% and 4.32 cm in patients compared with minor caliber changes of 8.8% and 2.31 cm in normal controls (p << 0.0001). For the phantoms an excellent correlation between the true and computed 3-D cross-sectional profile was found (p << 0.005) and an accuracy for length and degree measurements of 2.14 mm and 2.53% respectively could be determined. The corresponding figures for the precision were found to be 0.92 mm and 2.56%. CONCLUSION LTT 3-D cross-sectional profiles permit objective, accurate and precise assessment of LTT caliber changes. Minor LTT caliber changes can be observed even in normals and, in case of an otherwise normal S-CT study, can be regarded as artifacts.
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Affiliation(s)
- Erich Sorantin
- Department of Radiology, University Hospital Graz, Austria.
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Hertzog JH, Cartie RJ, Hauser GJ, Dalton HJ, Cleary K. The use of a mobile computed tomography scanner in the pediatric intensive care unit to evaluate airway stenting and lung volumes with varying levels of positive end-expiratory pressure. Pediatr Crit Care Med 2001; 2:346-8. [PMID: 12793939 DOI: 10.1097/00130478-200110000-00012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Presentation of a case report describing the use of a mobile computed tomography (CT) scanner in the pediatric intensive care unit (PICU) to radiographically evaluate tracheobronchial stenting and lung volumes while using different levels of positive end-expiratory pressure (PEEP) and positioning in a critically ill infant. DESIGN Case report of a single patient. SETTING Pediatric intensive care unit in a University Hospital. PATIENT A 6-month-old premature infant with bronchopulmonary dysplasia, tracheobronchomalacia, and progressive respiratory failure. INTERVENTIONS CT scans of the chest were performed by using a mobile CT scanner in the PICU. Serial CT scans were performed at PEEP levels of 5, 10, 15, and 20 cm H(2)O in both the supine and prone position. Scheduled medical care and standard monitoring were continued during the course of the CT scans. MEASUREMENTS AND MAIN RESULTS Identical anatomic levels demonstrating the trachea, bronchi, and lung parenchyma were compared while different levels of PEEP and supine or prone positioning were used. From these comparisons, the level of PEEP in which lung volumes were optimized was radiographically determined. No significant changes in large airway caliber were observed. There was no difference noted between prone and supine positioning. CT scans were completed with minimal disruption to the patient's care. CONCLUSIONS Mobile CT scanners can be used in the PICU for the diagnostic evaluation of critically ill children. This option allows for the continuation of medical therapies and monitoring in the intensive care setting while avoiding the potential complications of transporting a critically ill child to the radiology department. The use of mobile CT scanners may disrupt PICU routine and is more expensive than use of fixed CT scanners. Mobile CT scanners may be useful in radiographically determining the optimal level of PEEP in infants with tracheobronchomalacia and bronchopulmonary dysplasia.
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Affiliation(s)
- J H Hertzog
- Department of Pediatrics, Division of Pediatric Critical Care and Pulmonary Medicine, Georgetown University Medical Center, Washington, DC, USA.
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Hein E, Rogalla P, Hentschel C, Taupitz M, Hamm B. Dynamic and quantitative assessment of tracheomalacia by electron beam tomography: correlation with clinical symptoms and bronchoscopy. J Comput Assist Tomogr 2000; 24:247-52. [PMID: 10752886 DOI: 10.1097/00004728-200003000-00011] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the performance of electron beam tomography (EBT) in the dynamic and quantitative assessment of tracheal collapse in tracheomalacia. METHOD Eight patients with suspected tracheomalacia were evaluated by EBT, and the results were correlated with both clinical symptoms and bronchoscopy. To validate this technique, an EBT phantom study preceded the patients' examination. A dynamic imaging sequence consisting of 20 50-ms scans obtained at 0.5 s intervals during a 10 s period was performed while the patient followed an instructed breathing maneuver. RESULTS Good correlation between EBT data and clinical symptoms was found in all patients. In comparison to bronchoscopic findings, EBT results correlated well in three, showed limited correlation in three patients, and no correlation in one case. CONCLUSION EBT with its short scanning time may be regarded as an accurate noninvasive method to dynamically evaluate tracheomalacia.
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Affiliation(s)
- E Hein
- Department of Radiology, Charité Hospital, Humboldt-Universität zu Berlin, Germany
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Abstract
Radiologic evaluation of the airway has been used as a screening tool and an adjunct to endoscopy for many years. It provides noninvasive data on the structure of the airway while avoiding the risk of general anesthesia. In the past, standard radiographs provided only a shadow of the intricate anatomy of the pediatric airway. Not only have there been advances in static imaging but there now exists technology that enable noninvasive dynamic imaging and new techniques for image-guided intervention within the airway. This article focuses on four specific areas: airway fluoroscopy, functional swallow studies, controlled ventilation computed tomography, and interventional airway techniques.
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Affiliation(s)
- G J Wiet
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Department of Otolaryngology, Ohio State University College of Medicine and Public Health, Columbus, OH, USA
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Kauczor HU, Heussel CP, Fischer B, Klamm R, Mildenberger P, Thelen M. Assessment of lung volumes using helical CT at inspiration and expiration: comparison with pulmonary function tests. AJR Am J Roentgenol 1998; 171:1091-5. [PMID: 9763003 DOI: 10.2214/ajr.171.4.9763003] [Citation(s) in RCA: 117] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE This study was designed to determine lung volumes using inspiratory and expiratory helical CT with two-dimensional (2D) and three-dimensional (3D) postprocessing and to compare the accuracy of those measurements with pulmonary function test results. SUBJECTS AND METHODS Seventy-two patients with suspected pulmonary disease underwent unenhanced helical CT (slice thickness, 8 mm; pitch, 2; increment, 8 mm) at deep inspiration and expiration. Lung volumes were determined using either a 2D approach (semiautomatic segmentation; thresholds, -1024 and -200 H) or a 3D technique (double-threshold seeded volumes of interest; thresholds, -1024 H [lower] and -900, -500, 400, -300, or -200 H [upper]). Pulmonary function tests were available for correlation in all cases. RESULTS Using inspiratory helical CT, we underestimated total lung capacity by 12%, which had a good correlation (r = .89) with static lung volumes. Volume revealed by expiratory helical CT was equivalent to intrathoracic gas volume, which also exhibited a good correlation (r = .88). However, using expiratory helical CT, we overestimated residual volume by 850 ml with a rather good correlation (r = .77). An emphysema index revealed moderate correlation with the relative forced expiratory volume in 1 sec (inspiration, r = -.66; expiration, r = -.54), whereas the expired volume showed a moderate correlation with the absolute forced expiratory volume in 1 sec (r = .65). The 2D approach showed lower absolute volumes than the 3D technique (mean, 3.6%; r = .99). In the 3D technique, lower upper thresholds led to reduced volumes (170 ml/100 H). CONCLUSION Inspiratory and expiratory helical CT show high correlation with static lung volumes. The 3D technique (-1024 to -200 H) is recommended for absolute estimation of lung volumes.
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Affiliation(s)
- H U Kauczor
- Department of Radiology, Klinik fuer Radiologie, Johannes Gutenberg-Universitaet Mainz, Germany
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Abstract
Although high-resolution CT scan has proved most useful in the diagnosis of infiltrative lung disease, its use in the diagnosis of airway and obstructive lung diseases has recently been emphasized. In particular, the use of dynamic expiratory or postexpiratory CT scans, usually in combination with an inspiratory high-resolution CT scan study, has proved useful in the diagnosis and assessment of obstructive lung diseases. This article reviews the use of expiratory CT scan in the diagnosis of lung disease, including the various CT scan techniques that can be used, normal and abnormal expiratory CT scan findings, and the use of expiratory CT scan in a variety of obstructive diseases.
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Affiliation(s)
- H Arakawa
- Department of Radiology, University of California-San Francisco, USA
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Rozycki HJ, Van Houten ML, Elliott GR. Quantitative assessment of intrathoracic airway collapse in infants and children with tracheobronchomalacia. Pediatr Pulmonol 1996; 21:241-5. [PMID: 9121854 DOI: 10.1002/(sici)1099-0496(199604)21:4<241::aid-ppul7>3.0.co;2-r] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Tracheobronchomalacia (TBM) is increasingly recognized in infants, children, and adults with acquired chronic lung diseases as the use of flexible bronchoscopy has become widely established in spontaneously breathing patients. However, the lack of a reliable method to quantify the severity of the airway collapse has made serial studies, evaluation of therapies, and comparisons between patients difficult. The purpose of this study was to describe a method of quantifying airway collapse in TBM. The degree of airway collapse was quantitated by measuring the ratio of the smallest to the largest airway area during a respiratory cycle. The videotape of flexible bronchoscopy was run through a video monitor and frozen at the appropriate times. The airway circumference was then traced onto plastic overlays and the area measured. The videotapes of seven infants and children with TBM and eight with normal airways were reviewed by investigators who did not know the diagnosis. Intra-observer variability was 2.2%, and inter-observer variability was 1.4%. The mean smallest/largest airway ratio was 0.34 + or - 0.14 (SD) in the subjects with known TBM, compared with a ratio of 0.82 + or - 0.08 (SD) in children with a normal airway (P< 0.0001). The range in the children with TBM was 0.22-0.61, whereas for the control children it was 0.73-0.93. In this series, there was no overlap in the ratios between affected and unaffected patients. In addition to the manual method of calculating airway area ratios, a computer-assisted method is described that could be adapted to real-time use. This way of analyzing the degree of airway collapse could be used to assess patients with TBM quantitatively and reproducibly.
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Affiliation(s)
- H J Rozycki
- Divisions of Neonatal-Perinatal Medicine and Pediatric Pulmonology, Department of Pediatrics, Medical College of Virginia/Virginia Commonwealth University, Richmond, USA
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ULTRAFAST COMPUTED TOMOGRAPHY OF THE CHEST. Radiol Clin North Am 1994. [DOI: 10.1016/s0033-8389(22)00408-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Abstract
A boy with subglottic narrowing secondary to laryngotracheitis presented with noisy breathing. Acoustic measurements of tracheal sounds at standardized air flows correlated well with the clinical course and with spirometric assessments. This indicates the potential value of respiratory sound characterization in patients with upper airway obstruction.
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Affiliation(s)
- H Pasterkamp
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada
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Kimura K, Soper RT, Kao SC, Sato Y, Smith WL, Franken EA. Aortosternopexy for tracheomalacia following repair of esophageal atresia: evaluation by cine-CT and technical refinement. J Pediatr Surg 1990; 25:769-72. [PMID: 2380894 DOI: 10.1016/s0022-3468(05)80016-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
During the period of 1 year (1988 to 1989), five infants, aged 3 weeks to 10 months, presented with recurrent respiratory distress following repair of esophageal atresia with tracheoesphageal fistula (EA/TEF). These patients had associated congenital anomalies, including right aortic arch (1), biliary atresia (1), and a long gap that required esophageal elongation by spiral myotomy (1). The patients were evaluated for tracheomalacia using cinecomputed tomography (cine-CT; C-100 Scanner, Imatron, San Francisco, CA), which provides images of eight levels (8-mm interval) simultaneously with 0.7 second time intervals of cine-CT. Dynamic studies of the trachea by cine-CT showed tracheal collapse that was most significant during expiration in the segment immediately above and at the aortic arch. These patients underwent aortosternopexy. Via a right second intercostal approach, the ascending aorta and aortic arch were lifted anteriorly using two to four sutures of 5-0 Tevdek on pledgets placed between the tunica media and adventitia of the side walls of the aorta and the adjacent sternum. Respiratory distress was significantly improved postoperatively. Preliminary experience with these patients allows us to conclude that (1) cine-CT is a useful technique for diagnosing tracheomalacia; (2) it provides objective indication for its correction by aortosternopexy; and (3) the refined technique in placing sutures on the aorta may reduce the surgical risks of aortosternopexy.
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Affiliation(s)
- K Kimura
- Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City 52242
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Griscom NT, Martin TR. The trachea and esophagus after repair of esophageal atresia and distal fistula: computed tomographic observations. Pediatr Radiol 1990; 20:447-50. [PMID: 2392361 DOI: 10.1007/bf02075205] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Five patients, whose esophageal atresia and distal tracheoesophageal fistula had been repaired in infancy, were examined by computed tomography at age 2 to 21 because of recurrent or persistent tracheal or esophageal problems. Their tracheas generally failed to have the roughly circular cross-sectional shape found in controls. The pars membranacea was often unusually broad, with much more section-to-section variation in area than in controls. Change in cross-sectional area with respiratory phase, in the one patient assessed, was much greater than in a control. These tracheal abnormalities help to explain the tracheal symptoms found in these and similar patients. Their esophagi contained much air and fluid.
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Affiliation(s)
- N T Griscom
- Department of Radiology, Harvard Medical School, Boston, Massachusetts
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