Causes of Persistent Obstructive Sleep Apnea Despite Previous Tonsillectomy and Adenoidectomy in Children with Down Syndrome as Depicted on Static and Dynamic Cine MRI
Lane F. Donnelly1,2,
Sally R. Shott3,
Connor R. LaRose1,
Barbara A. Chini2,4 and
Raouf S. Amin2,4
1 Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333
Burnet Ave., Cincinnati, OH 45229-3039.
2 Department of Pediatrics, Cincinnati Children's Hospital Medical Center,
Cincinnati, OH 45229-3039.
3 Department of Otolaryngology, Cincinnati Children's Hospital Medical Center,
Cincinnati, OH 45229-3039.
4 Department of Pulmonology, Cincinnati Children's Hospital Medical Center,
Cincinnati, OH 45229-3039.
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Fig. 1A. —Recurrent enlargement of adenoid tonsils in 10-year-old girl
with Down syndrome and persistent obstructive sleep apnea despite previous
tonsillectomy and adenoidectomy. A = adenoid tissue. Sagittal T1-weighted
image shows recurrent and enlarged adenoid tissue narrowing posterior
nasopharynx (arrow). Macroglossia is also present.
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Fig. 1B. —Recurrent enlargement of adenoid tonsils in 10-year-old girl
with Down syndrome and persistent obstructive sleep apnea despite previous
tonsillectomy and adenoidectomy. A = adenoid tissue. Sagittal fast spin-echo
inversion recovery image shows recurrent and enlarged adenoid tissue as
increased signal, narrowing posterior nasopharynx (arrow).
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Fig. 1C. —Recurrent enlargement of adenoid tonsils in 10-year-old girl
with Down syndrome and persistent obstructive sleep apnea despite previous
tonsillectomy and adenoidectomy. A = adenoid tissue. Axial fast spin-echo
inversion recovery image shows recurrent and enlarged adenoid tissue as
increased signal, narrowing posterior nasopharynx (arrow).
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Fig. 1D. —Recurrent enlargement of adenoid tonsils in 10-year-old girl
with Down syndrome and persistent obstructive sleep apnea despite previous
tonsillectomy and adenoidectomy. A = adenoid tissue. Consecutive images from
sagittal cine MRI sequence show enlarged adenoid tissue. Posterior nasopharynx
(large arrow) and hypopharynx (small arrows, E) are
well-defined and show low signal in D and are poorly defined and show
high signal in E. Cine display of images showed intermittent collapse
of nasopharynx and hypopharynx.
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Fig. 1E. —Recurrent enlargement of adenoid tonsils in 10-year-old girl
with Down syndrome and persistent obstructive sleep apnea despite previous
tonsillectomy and adenoidectomy. A = adenoid tissue. Consecutive images from
sagittal cine MRI sequence show enlarged adenoid tissue. Posterior nasopharynx
(large arrow) and hypopharynx (small arrows, E) are
well-defined and show low signal in D and are poorly defined and show
high signal in E. Cine display of images showed intermittent collapse
of nasopharynx and hypopharynx.
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Fig. 2A. —Recurrent enlargement of adenoid tonsils in 7-year-old boy
with Down syndrome and persistent obstructive sleep apnea despite previous
tonsillectomy and adenoidectomy. Consecutive images from cine MRI sequence
show enlarged adenoid tissue (A on A). In A, nasopharynx
(small arrow) and hypopharynx (large arrows) are patent. In
B, nasopharynx (small arrows) and hypopharynx (large
arrows) have decreased in caliber and are nearly collapsed. Cine display
of images showed intermittent collapse of nasopharynx and hypopharynx.
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Fig. 2B. —Recurrent enlargement of adenoid tonsils in 7-year-old boy
with Down syndrome and persistent obstructive sleep apnea despite previous
tonsillectomy and adenoidectomy. Consecutive images from cine MRI sequence
show enlarged adenoid tissue (A on A). In A, nasopharynx
(small arrow) and hypopharynx (large arrows) are patent. In
B, nasopharynx (small arrows) and hypopharynx (large
arrows) have decreased in caliber and are nearly collapsed. Cine display
of images showed intermittent collapse of nasopharynx and hypopharynx.
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Fig. 3A. —Enlarged lingual tonsils obstructing hypopharynx in
10-year-old boy with Down syndrome and persistent obstructive sleep apnea
despite previous tonsillectomy and adenoidectomy. Axial (A) and
sagittal (B) fast spin-echo inversion recovery images show high-signal
lingual tonsil (L) at level of base of tongue, filling and obstructing
hypopharynx. Recurrence of adenoid tissue (A) is also seen in B.
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Fig. 3B. —Enlarged lingual tonsils obstructing hypopharynx in
10-year-old boy with Down syndrome and persistent obstructive sleep apnea
despite previous tonsillectomy and adenoidectomy. Axial (A) and
sagittal (B) fast spin-echo inversion recovery images show high-signal
lingual tonsil (L) at level of base of tongue, filling and obstructing
hypopharynx. Recurrence of adenoid tissue (A) is also seen in B.
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Fig. 3C. —Enlarged lingual tonsils obstructing hypopharynx in
10-year-old boy with Down syndrome and persistent obstructive sleep apnea
despite previous tonsillectomy and adenoidectomy. Consecutive images from cine
MRI sequence show that lingual tonsils are not seen in region of hypopharynx
(C). In D, lingual tonsils (L) are seen filling and obstructing
hypopharynx. Cine display of images showed intermittent inferior and central
motion of lingual tonsils intermittently obstructing hypopharynx.
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Fig. 3D. —Enlarged lingual tonsils obstructing hypopharynx in
10-year-old boy with Down syndrome and persistent obstructive sleep apnea
despite previous tonsillectomy and adenoidectomy. Consecutive images from cine
MRI sequence show that lingual tonsils are not seen in region of hypopharynx
(C). In D, lingual tonsils (L) are seen filling and obstructing
hypopharynx. Cine display of images showed intermittent inferior and central
motion of lingual tonsils intermittently obstructing hypopharynx.
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Fig. 4A. —Glossoptosis with associated lack of median sulcus and fatty
infiltration of tongue musculature in 12-year-old boy with Down syndrome and
persistent obstructive sleep apnea despite previous tonsillectomy and
adenoidectomy. Midline sagittal T1-weighted spin-echo image shows macroglossia
with encroachment on small-caliber hypopharynx (large arrow).
Increased signal (small arrow) is present in musculature of tongue,
consistent with fatty infiltration.
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Fig. 4B. —Glossoptosis with associated lack of median sulcus and fatty
infiltration of tongue musculature in 12-year-old boy with Down syndrome and
persistent obstructive sleep apnea despite previous tonsillectomy and
adenoidectomy. Consecutive images from axial cine MRI sequence show that
hypopharynx (arrow, C) is decreased on both images. Interval
decrease in diameter occurs from B to C. Cine display of images
showed intermittent posterior motion of tongue, consistent with glossoptosis
and resulting in intermittent obstruction of hypopharynx.
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Fig. 4C. —Glossoptosis with associated lack of median sulcus and fatty
infiltration of tongue musculature in 12-year-old boy with Down syndrome and
persistent obstructive sleep apnea despite previous tonsillectomy and
adenoidectomy. Consecutive images from axial cine MRI sequence show that
hypopharynx (arrow, C) is decreased on both images. Interval
decrease in diameter occurs from B to C. Cine display of images
showed intermittent posterior motion of tongue, consistent with glossoptosis
and resulting in intermittent obstruction of hypopharynx.
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Fig. 4D. —Glossoptosis with associated lack of median sulcus and fatty
infiltration of tongue musculature in 12-year-old boy with Down syndrome and
persistent obstructive sleep apnea despite previous tonsillectomy and
adenoidectomy. Axial fast spin-echo inversion recovery image shows lack of
normal median sulcus and small-caliber hypopharynx (arrow).
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Fig. 4E. —Glossoptosis with associated lack of median sulcus and fatty
infiltration of tongue musculature in 12-year-old boy with Down syndrome and
persistent obstructive sleep apnea despite previous tonsillectomy and
adenoidectomy. For comparison purposes, axial fast spin-echo inversion
recovery image of 12-year-old boy with obstructive sleep apnea but not Down
syndrome shows normal appearance of median sulcus (arrow) of
tongue.
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Fig. 5A. —Macroglossia and glossoptosis in 18-year-old woman with Down
syndrome and persistent obstructive sleep apnea despite previous tonsillectomy
and adenoidectomy. Consecutive images from sagittal cine MRI sequence show
macroglossia with posterior aspect of tongue (arrows) encroaching on
hypopharynx. Interval decrease in caliber of hypopharynx with associated
obstruction occurs from A to B. Cine display of images showed
intermittent posterior motion of tongue, consistent with glossoptosis and
resulting in intermittent obstruction of hypopharynx.
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Fig. 5B. —Macroglossia and glossoptosis in 18-year-old woman with Down
syndrome and persistent obstructive sleep apnea despite previous tonsillectomy
and adenoidectomy. Consecutive images from sagittal cine MRI sequence show
macroglossia with posterior aspect of tongue (arrows) encroaching on
hypopharynx. Interval decrease in caliber of hypopharynx with associated
obstruction occurs from A to B. Cine display of images showed
intermittent posterior motion of tongue, consistent with glossoptosis and
resulting in intermittent obstruction of hypopharynx.
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Copyright © 2004 by the American Roentgen Ray Society.
