Noninvasive Imaging Study of Tracheobronchial Compression Caused By Tortuosity and Dilation of the Thoracic Artery

Objective: To demonstrate tracheobronchial compression caused by tortuous and dilated large and medium-sized thoracic arteries and the characteristics of these arteries by noninvasive imaging modalities. Patients and Methods: Imaging and clinical data of six patients with tortuous, dilated large and medium-sized thoracic arteries (July 2007 to December 2013) were reviewed. The imaging data were mainly acquired by cardiac multi-slice computed tomography (MSCT) or/and cardiac magnetic resonance imaging (MRI). The number and location of tracheobronchial stenosis were noted, and the severity of stenosis was categorized. The characteristics of large and medium-sized thoracic arteries were also noted. Further, the correlation between the severity of tracheobronchial stenosis and tortuous, dilated large and medium-sized thoracic arteries was analyzed. One patient who was suspected to have arterial tortuosity syndrome underwent genetic analysis. Results: All six patients demonstrated varying degrees of tortuosity and dilation of large and medium-sized thoracic arteries. Five were noted to have varying degrees of tracheobronchial compression and respiratory symptoms. Two have varying degrees of connective tissue abnormalities. Conclusion: Tracheobronchial compression of tortuosity and dilation of large and medium-sized thoracic vascular origin is an uncommon and frequently unrecognized cause of respiratory distress in children. Noninvasive imaging modalities like MSCT and MRI could clearly demonstrate tracheobronchial compression and vascular abnormalities simultaneously. Attention should be given to tracheobronchial compression when disease management decisions are made, especially for determining surgical strategies and for those patients who are 6-9 months old.B. MAB is frequent in patients with COPD and is associated with hypoxemia independent of other cardiovascular risk factors.