Imaging Findings in Pediatric Patients with Persistent Airway Symptoms After Surgery for Double Aortic Arch
Robert J. Fleck1,2,
Preeyacha Pacharn1,3,
Bradley L. Fricke1,
Matthew A. Ziegler1,
Robin T. Cotton4 and
Lane F. Donnelly1
1 Department of Radiology, Children's Hospital Medical Center, 3333 Burnet Ave.,
Cincinnati, OH 45229-3039.
2 Present address: Department of Radiology, Naval Medical Center, San Diego, CA
92134-1204.
3 Present address: Department of Radiology, Mahidol University, Bangkok,
Thailand 10700.
4 Division of Otolaryngology, Children's Hospital Medical Center, Cincinnati, OH
45229.
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Fig. 1A. —Airway compression at level of trachea in 1-year-old girl
after repair of double aortic arch. Contrast-enhanced CT image obtained at
time of initial diagnosis shows double aortic arch (arrowheads) with
marked airway compression (arrow).
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Fig. 1B. —Airway compression at level of trachea in 1-year-old girl
after repair of double aortic arch. Contrast-enhanced CT image obtained at
time of reimaging 1 month after surgery shows trachea (large arrow)
to be narrowed between left arch (small arrows) and persistent
portion of right arch (arrowhead), which was retained to connect to
right subclavian and common carotid arteries.
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Fig. 1C. —Airway compression at level of trachea in 1-year-old girl
after repair of double aortic arch. Surface-rendered three-dimensional CT
image shows narrowing (arrows) of caliber of trachea (T) at level of
arch. Esophagus (E) is also dilated and air-filled above this level. Some
aerated lung is also present.
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Fig. 1D. —Airway compression at level of trachea in 1-year-old girl
after repair of double aortic arch. Endoscopic image shows narrowing of
trachea (arrows) that is both fixed and pulsatile.
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Fig. 2A. —Airway compression at level of trachea and left main bronchus
in 17-month-old boy after repair of double aortic arch. CT image from time of
initial diagnosis at 1 week of life shows double aortic arch compressing
trachea. Left arch (arrows) is larger than right arch
(arrowheads). Endotracheal tube is in trachea. Patient underwent
surgical ligation of smaller, right arch.
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Fig. 2B. —Airway compression at level of trachea and left main bronchus
in 17-month-old boy after repair of double aortic arch. Axial T1-weighted MR
image obtained after surgery at level of persistent left arch (A) and anterior
segment of right arch (arrowhead) shows trachea (arrow) to
be oblong and slightly narrowed.
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Fig. 2C. —Airway compression at level of trachea and left main bronchus
in 17-month-old boy after repair of double aortic arch. Endoscopic image shows
fixed, pulsatile narrowing of trachea.
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Fig. 2D. —Airway compression at level of trachea and left main bronchus
in 17-month-old boy after repair of double aortic arch. Axial T1-weighted MR
image obtained at lower level shows descending aorta (D) to be in midline
position, immediately anterior to spine. Left main bronchus (arrow)
is compressed between abnormally positioned descending aorta and right
pulmonary artery (P) and is much narrower in diameter than right main bronchus
(arrowhead).
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Fig. 2E. —Airway compression at level of trachea and left main bronchus
in 17-month-old boy after repair of double aortic arch. Endoscopic image,
oriented as MR images in B and D, shows compression of left main
bronchus (arrows), which is much smaller in diameter than right main
bronchus (arrowheads). Narrowing was fixed and pulsatile.
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Copyright © 2002 by the American Roentgen Ray Society.
