Innominate artery compression of the trachea in a 9-month-old previously healthy male: A case report

Jessica Carullo, Anayansi Lasso-Pirot, Nidhi Kotwal
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Abstract

Introduction

Innominate Artery Compression of the Trachea (IACT) is rare but can cause stridor in infancy. IACT involves anterior compression of the trachea as the innominate (brachiocephalic) artery originates later along the transverse portion of the aortic arch. We present a case of IACT in a previously healthy 9-month-old male that failed to respond to medical therapy. This case demonstrates an unusual, delayed presentation of IACT.

Case presentation

Our patient is a 9-month-old previously healthy male presenting to the outpatient pulmonology clinic with a one-month history of stridor. Patient initially presented to outside providers and prescribed systemic steroid courses, which failed to improve the stridor. On exam, patient demonstrated respiratory distress and biphasic stridor that worsened when feeding from a bottle. Patient was admitted from clinic for further evaluation by ENT. Initial chest radiographs showed findings consistent with viral lower respiratory infection versus reactive airway disease and no radiopaque foreign body. Bedside scope was performed by ENT, which did not show obstruction or foreign body above the level of the glottis. Computed tomography (CT) without contrast was performed per ENT recommendations, which showed focal tracheal narrowing but significant movement artifact. To provide further clarification on the tracheal narrowing, a direct bronchoscopy was performed by ENT, which showed tracheal compression at the level of the thoracic inlet. Computed Tomographic Angiography (CTA) of the chest confirmed the diagnosis of IACT. Patient underwent arterial relocation and reimplantation, and the tracheal compression was markedly improved on repeat bronchoscopy. Patient recovered from the procedure well with improvement in stridor and respiratory distress. Patient was discharged on POD3 and followed up in pulmonology clinic with resolution of stridor and no residual respiratory symptoms.

Conclusion

This case particularly highlights the importance of continued investigation into persistent stridor that is refractory to medications, with special consideration for congenital causes.

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一名 9 个月大的健康男性气管受腹内动脉压迫:病例报告
导言:气管贲门动脉压迫症(IACT)非常罕见,但在婴儿期可导致呼吸困难。IACT 涉及气管前部受压,因为贲门(肱)动脉发源于主动脉弓的横向部分。我们介绍了一例 IACT 病例,患者是一名 9 个月大的男性,之前身体健康,但对药物治疗无效。本病例展示了一种不寻常的延迟性 IACT。病例介绍我们的患者是一名 9 个月大的男性,之前身体健康,因有一个月的呼吸困难病史而到肺科门诊就诊。患者最初在外部医疗机构就诊,医生为其开具了全身类固醇处方,但未能改善呼吸困难。检查时,患者表现出呼吸困难和双相性喘鸣,用奶瓶喂食时喘鸣加剧。患者被从诊所转入耳鼻喉科接受进一步评估。初步胸片检查结果显示,患者为病毒性下呼吸道感染,而非反应性气道疾病,且无放射性异物。耳鼻喉科医生进行了床边检查,未发现声门上方有阻塞或异物。根据耳鼻喉科的建议,进行了无造影剂计算机断层扫描(CT),结果显示气管局灶性狭窄,但运动伪影明显。为了进一步明确气管狭窄的情况,耳鼻喉科医生为患者进行了直接支气管镜检查,结果显示气管在胸腔入口处受压。胸部计算机断层扫描(CTA)证实了 IACT 的诊断。患者接受了动脉移位和再植手术,再次接受支气管镜检查时,气管受压情况明显好转。患者术后恢复良好,喘鸣和呼吸困难有所改善。患者于 POD3 出院,并在肺科门诊进行了随访,呼吸困难症状得到缓解,无呼吸道症状残留。 结论:该病例特别强调了对药物治疗无效的持续性呼吸困难进行持续调查的重要性,并特别考虑了先天性原因。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
0.60
自引率
25.00%
发文量
348
审稿时长
15 days
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