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

Zhong YM, Jaffe RB, Liu JF, Sun AM, Gao W, Wang Q, Zhu M, Qiu HS, Berdon WE - Pediatr Radiol (2014)

Bottom Line: Absent pulmonary valve is a rare cardiovascular anomaly that can result in profound tracheobronchial compression.The diameter of the pulmonary artery was measured and associated cardiac defects were demonstrated.Multi-slice CT can accurately depict areas of tracheobronchial compression, associated lung lesions and cardiac defects, helping to direct the surgeon.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Shanghai Children's Medical Center and Shanghai Jiao Tong University Medical School, Shanghai, China.

ABSTRACT

Background: Absent pulmonary valve is a rare cardiovascular anomaly that can result in profound tracheobronchial compression.

Objective: To 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 methods: We 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.

Results: Thirty-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.

Conclusion: Absent 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.

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Related in: MedlinePlus

Multi-slice CT findings of severity of tracheobronchial compression. a Absent pulmonary valve with tetralogy of Fallot in a 7-year-old boy. The multi-slice CT coronal minimum-intensity projection demonstrates mild left bronchial compression (arrow). b Absent pulmonary valve syndrome with tetralogy of Fallot in a 4-month-old girl. Multi-slice CT coronal minimum-intensity projection reconstruction demonstrates moderate right and left bronchial compression (arrows). The two vertical black lines are part of an esophageal tube (arrowhead). c Absent pulmonary valve syndrome with tetralogy of Fallot in a 10-month-old girl. Multi-slice CT coronal minimum-intensity projection reconstruction demonstrates severe right tracheal bronchus stenosis and right bronchial compression and moderate left bronchus stenosis (arrows). Right middle lobar and lower lobar emphysema are present (arrowhead)
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Fig1: Multi-slice CT findings of severity of tracheobronchial compression. a Absent pulmonary valve with tetralogy of Fallot in a 7-year-old boy. The multi-slice CT coronal minimum-intensity projection demonstrates mild left bronchial compression (arrow). b Absent pulmonary valve syndrome with tetralogy of Fallot in a 4-month-old girl. Multi-slice CT coronal minimum-intensity projection reconstruction demonstrates moderate right and left bronchial compression (arrows). The two vertical black lines are part of an esophageal tube (arrowhead). c Absent pulmonary valve syndrome with tetralogy of Fallot in a 10-month-old girl. Multi-slice CT coronal minimum-intensity projection reconstruction demonstrates severe right tracheal bronchus stenosis and right bronchial compression and moderate left bronchus stenosis (arrows). Right middle lobar and lower lobar emphysema are present (arrowhead)

Mentions: Twenty-nine children had tracheobronchial stenosis (94%). Of these 29 children, 31% (9/29) had mild stenosis, 34% (10/29) had moderate stenosis and 34% (10/29) of cases had severe bronchial stenosis (Fig. 1) (Table 2). The different locations of stenosis (carina, main bronchi, lobar and segmental bronchi) were observed. Forty-five percent (14/31) of the children had carina compression, 77% (24/31) had main bronchi compression and 65% (20/31) had lobar or segmental bronchial compression (Fig. 2). The number and location of lung lesions (atelectasis, emphysema) was also identified. In 29 children who had tracheobronchial stenosis, the right middle lobe, left upper lobe and left lower lobe were most often affected (Table 2).Fig. 1


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

Zhong YM, Jaffe RB, Liu JF, Sun AM, Gao W, Wang Q, Zhu M, Qiu HS, Berdon WE - Pediatr Radiol (2014)

Multi-slice CT findings of severity of tracheobronchial compression. a Absent pulmonary valve with tetralogy of Fallot in a 7-year-old boy. The multi-slice CT coronal minimum-intensity projection demonstrates mild left bronchial compression (arrow). b Absent pulmonary valve syndrome with tetralogy of Fallot in a 4-month-old girl. Multi-slice CT coronal minimum-intensity projection reconstruction demonstrates moderate right and left bronchial compression (arrows). The two vertical black lines are part of an esophageal tube (arrowhead). c Absent pulmonary valve syndrome with tetralogy of Fallot in a 10-month-old girl. Multi-slice CT coronal minimum-intensity projection reconstruction demonstrates severe right tracheal bronchus stenosis and right bronchial compression and moderate left bronchus stenosis (arrows). Right middle lobar and lower lobar emphysema are present (arrowhead)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC4061480&req=5

Fig1: Multi-slice CT findings of severity of tracheobronchial compression. a Absent pulmonary valve with tetralogy of Fallot in a 7-year-old boy. The multi-slice CT coronal minimum-intensity projection demonstrates mild left bronchial compression (arrow). b Absent pulmonary valve syndrome with tetralogy of Fallot in a 4-month-old girl. Multi-slice CT coronal minimum-intensity projection reconstruction demonstrates moderate right and left bronchial compression (arrows). The two vertical black lines are part of an esophageal tube (arrowhead). c Absent pulmonary valve syndrome with tetralogy of Fallot in a 10-month-old girl. Multi-slice CT coronal minimum-intensity projection reconstruction demonstrates severe right tracheal bronchus stenosis and right bronchial compression and moderate left bronchus stenosis (arrows). Right middle lobar and lower lobar emphysema are present (arrowhead)
Mentions: Twenty-nine children had tracheobronchial stenosis (94%). Of these 29 children, 31% (9/29) had mild stenosis, 34% (10/29) had moderate stenosis and 34% (10/29) of cases had severe bronchial stenosis (Fig. 1) (Table 2). The different locations of stenosis (carina, main bronchi, lobar and segmental bronchi) were observed. Forty-five percent (14/31) of the children had carina compression, 77% (24/31) had main bronchi compression and 65% (20/31) had lobar or segmental bronchial compression (Fig. 2). The number and location of lung lesions (atelectasis, emphysema) was also identified. In 29 children who had tracheobronchial stenosis, the right middle lobe, left upper lobe and left lower lobe were most often affected (Table 2).Fig. 1

Bottom Line: Absent pulmonary valve is a rare cardiovascular anomaly that can result in profound tracheobronchial compression.The diameter of the pulmonary artery was measured and associated cardiac defects were demonstrated.Multi-slice CT can accurately depict areas of tracheobronchial compression, associated lung lesions and cardiac defects, helping to direct the surgeon.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Shanghai Children's Medical Center and Shanghai Jiao Tong University Medical School, Shanghai, China.

ABSTRACT

Background: Absent pulmonary valve is a rare cardiovascular anomaly that can result in profound tracheobronchial compression.

Objective: To 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 methods: We 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.

Results: Thirty-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.

Conclusion: Absent 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.

Show MeSH
Related in: MedlinePlus