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Routine multi detector computed tomography evaluation of tracheal impairment compared to laryngo-tracheal endoscopy in children with vascular ring

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Abstract

Purpose

The aim of this study is to compare free-breathing routine multi detector computed tomography (MDCT) and laryngo-tracheal (LT) flexible endoscopy in the evaluation of tracheal impairment in children with vascular ring (VR).

Materials and methods

We performed a retrospective and monocentric study of all patients with VR from 1997 to 2014. Clinical data included: initial symptoms, type of surgery and clinical outcome. MDCT were blindly reviewed by two radiologists in consensus, independently of LT endoscopy results. Radiologic and endoscopic results were reviewed according to four criteria: percentage of tracheal narrowing, distance of the compression from carina, presence of bronchial compression and signs of tracheomalacia (TM). Concordance was evaluated for each criterion with a Spearman coefficient.

Results

From 1997 to 2016, 21 patients with a vascular ring were operated on, among which 57% by thoracoscopy: double aortic arch (n = 14), Neuhauser anomaly (n = 4) and Right aorta + aberrant right subclavian artery (n = 3). 90% of them presented with respiratory symptoms among which 43% of stridor. Chest X-ray was suggestive of VR in 87% of the cases. MDCT images and LT endoscopy results were available and analyzed for nine patients. Concordance (Spearman correlation coefficient) was excellent for percentage and level of tracheal narrowing (1) and good for TM (0.79).

Conclusion

Free breathing routine MDCT is a reliable exam compared to LT endoscopy in the evaluation of tracheal impairment in children with VR. In case of respiratory symptoms (except stridor) and suggestive chest X-ray of VR, endoscopy could be avoided and routine MDCT alone performed.

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Authors and Affiliations

  1. Pediatric Surgery Department, Robert Debré Hospital, APHP, 48 bvd Serrurier, 75019, Paris, France

    Cecile O. Muller, Lucie Derycke & Arnaud Bonnard

  2. Pediatric ENT Department, Robert Debré Hospital, APHP, Paris, France

    Sophie Bernard & Natacha Teissier

  3. Pediatric Radiology Department, Robert Debré Hospital, APHP, Paris, France

    Ahmed Kheniche & Gabriel Garcia

Authors
  1. Cecile O. Muller
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  2. Lucie Derycke
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  3. Ahmed Kheniche
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  4. Gabriel Garcia
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  5. Sophie Bernard
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  6. Natacha Teissier
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  7. Arnaud Bonnard
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Correspondence to Cecile O. Muller.

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The authors declare that they have no conflict of interest.

Research involving human participants and/or animals

This article does not contain any studies with human participants or animals performed by any of the authors.

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All data in this article are completely anonymous, therefore, this clinical study did not require any informed consent.

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Muller, C.O., Derycke, L., Kheniche, A. et al. Routine multi detector computed tomography evaluation of tracheal impairment compared to laryngo-tracheal endoscopy in children with vascular ring. Pediatr Surg Int 34, 879–884 (2018). https://doi.org/10.1007/s00383-018-4279-4

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  • DOI: https://doi.org/10.1007/s00383-018-4279-4

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