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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

Absent pulmonary valve syndrome with tetralogy of Fallot in a 4-month-old boy. a Multi-slice CT axial and (b) coronal minimum-intensity projection CT images demonstrate carina (arrowhead in a) and left main bronchial compression (arrow in b). Note the obstructive emphysema in the left lung and right middle lobe (arrows in a). c, d Bronchoscopy demonstrates carina compression (arrow in c) and left main bronchus bronchomalacia (arrow in d). e Multi-slice CT coronal minimum-intensity projection reconstruction 3 months after surgery in the same child, take picture from different angle demonstrates an improved appearance of the left bronchus (arrow) and considerable improvement in the right middle lobe and left lung obstructive emphysema (arrowhead)
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Fig4: Absent pulmonary valve syndrome with tetralogy of Fallot in a 4-month-old boy. a Multi-slice CT axial and (b) coronal minimum-intensity projection CT images demonstrate carina (arrowhead in a) and left main bronchial compression (arrow in b). Note the obstructive emphysema in the left lung and right middle lobe (arrows in a). c, d Bronchoscopy demonstrates carina compression (arrow in c) and left main bronchus bronchomalacia (arrow in d). e Multi-slice CT coronal minimum-intensity projection reconstruction 3 months after surgery in the same child, take picture from different angle demonstrates an improved appearance of the left bronchus (arrow) and considerable improvement in the right middle lobe and left lung obstructive emphysema (arrowhead)

Mentions: Bronchoscopy was performed in seven children. All seven had moderate to severe bronchomalacia adjacent to dilated pulmonary arteries (Fig. 4) (Table 4).Fig. 4


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)

Absent pulmonary valve syndrome with tetralogy of Fallot in a 4-month-old boy. a Multi-slice CT axial and (b) coronal minimum-intensity projection CT images demonstrate carina (arrowhead in a) and left main bronchial compression (arrow in b). Note the obstructive emphysema in the left lung and right middle lobe (arrows in a). c, d Bronchoscopy demonstrates carina compression (arrow in c) and left main bronchus bronchomalacia (arrow in d). e Multi-slice CT coronal minimum-intensity projection reconstruction 3 months after surgery in the same child, take picture from different angle demonstrates an improved appearance of the left bronchus (arrow) and considerable improvement in the right middle lobe and left lung obstructive emphysema (arrowhead)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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Fig4: Absent pulmonary valve syndrome with tetralogy of Fallot in a 4-month-old boy. a Multi-slice CT axial and (b) coronal minimum-intensity projection CT images demonstrate carina (arrowhead in a) and left main bronchial compression (arrow in b). Note the obstructive emphysema in the left lung and right middle lobe (arrows in a). c, d Bronchoscopy demonstrates carina compression (arrow in c) and left main bronchus bronchomalacia (arrow in d). e Multi-slice CT coronal minimum-intensity projection reconstruction 3 months after surgery in the same child, take picture from different angle demonstrates an improved appearance of the left bronchus (arrow) and considerable improvement in the right middle lobe and left lung obstructive emphysema (arrowhead)
Mentions: Bronchoscopy was performed in seven children. All seven had moderate to severe bronchomalacia adjacent to dilated pulmonary arteries (Fig. 4) (Table 4).Fig. 4

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