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Dynamic volumetric computed tomographic assessment of the young paediatric airway: Initial experience of rapid, non‐invasive, four‐dimensional technique
Author(s) -
Tan Judith ZhiYie,
Crossett Marcus,
Ditchfield Michael
Publication year - 2013
Publication title -
journal of medical imaging and radiation oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.31
H-Index - 43
eISSN - 1754-9485
pISSN - 1754-9477
DOI - 10.1111/1754-9485.12009
Subject(s) - tracheobronchomalacia , medicine , bronchography , tracheomalacia , bronchoscopy , airway , radiology , malacia , bronchiectasis , intubation , air trapping , lung , surgery , computed tomography
The aim of this study was to evaluate the dynamic volumetric CT in the assessment of the paediatric airway. Methods Ethics board approval was obtained for this retrospective review. Eight infants (median age 6 months, range 3 weeks to 1 year, 50% female) at a tertiary paediatric centre with complex clinical respiratory presentation underwent volumetric CT assessment of their airways. The entire lungs were examined over 1–2 respiratory cycles. In four patients, intravenous contrast was administered to assess for vascular airway compression. The patients were not intubated. CT findings were correlated with bronchography and bronchoscopy, where available. Results Two patients had diffuse tracheobronchomalacia associated with chronic lung disease. One patient demonstrated focal severe cervical tracheomalacia. One patient had a double aortic arch causing fixed narrowing with superimposed malacia of the distal trachea. Four patients had normal airways; one with chronic lung disease, one demonstrating air trapping. CT findings were concordant with bronchography (one case) and bronchoscopy (four cases) in all but one ( CT negative, bronchoscopy positive) but did not alter patient management. Conclusion The assessment of the paediatric airway, and in particular for tracheobronchomalacia, is difficult. Assessment with bronchography, bronchoscopy, helical CT and MR have issues with reliability, intubation, intratracheal/bronchial contrast administration and ionising radiation. Volumetric CT assesses the entire central airway in children at much lower radiation dose compared with previous dynamic CT imaging. This non‐invasive, rapid assessment obviates the need for patient cooperation and enables evaluation of extratracheal intrathoracic structures. Volumetric CT enables four‐dimensional assessment for paediatric tracheobronchomalacia without intubation or patient cooperation and at low radiation dose.