Vascular compression of the airway in children

Persistent airway compression in a 20-month-old boy following surgery for double aortic arch. (a) 3D CT reconstruction (posterosuperior view) shows the divided left arch and surgical clips (white arrows). The right arch is indicated by a red arrow. (b) Compression is most severe where the descending aorta (arrow) crosses from right to left behind the airway. (c) Frontal bronchography shows a right-sided impression on the trachea from the right aortic arch. (d) Lateral bronchography shows posterior compression by the descending aorta (arrows). (e) 2.2-mm flexible bronchoscopy shows extrinsic compression at the level of the carina.

A 4-month-old girl with compression of the left main bronchus following surgery for interrupted aortic arch. Axial CT of the thorax showing compression in the midline by the descending aorta (arrow).

A 5-year-old boy with a right-sided aortic arch and aberrant left subclavian artery. (a) Axial CT of the thorax showing compression of the trachea by the aberrant artery (arrow). (b) 3D volume rendered image (posterior view) shows the right-sided aortic arch (red arrow) and the aberrant left subclavian artery (white arrow) arising from the descending aorta.

Tetralogy of Fallot and absent pulmonary valve syndrome with airway compression in a 15-month-old boy. (a) CT volume rendered image shows compression of the left main bronchus (arrow). (b) Axial CT of the thorax shows severe compression of the airway between the vertebral body and the grossly enlarged pulmonary arteries. (c) Lateral bronchogram confirms severe anterior compression of the airway caused by the enlarged pulmonary arteries. (d) 2.2-mm flexible bronchoscopy shows canal compression.

A 12-month-old girl, ventilator-dependent, with dilated cardiomyopathy. (a) 2.2-mm flexible bronchoscopy shows compression of the left main bronchus (arrow). (b) On bronchography the left main bronchus is completely occluded with no passage of contrast into the left lung. (c) A self-expanding stent has been deployed. (d) Bronchoscopy shows good position of the stent, with patency of the left main bronchus.