Purpose: As an extremely rare abnormity, type IIA pulmonary artery sling (PAS) tracheobronchial anomalies should be differentiated from normal airway for therapeutic decision-making. This study aimed to investigate the quantitative characteristics of type IIA PAS tracheobronchial anomalies using dual-source computed tomography (DSCT).
Materials and methods: From January 2009 to December 2016, there were 11 type IIA PAS patients enrolled for analysis and compared with 32 controls. The areas of the trachea, right upper lobar bronchus, left main bronchus, right intermediate bronchus [bridging bronchus (BB) in patients], and subcarinal angle [subpseudocarinal angle in patients] were measured. Measurements other than that for the angle were standardized with body surface area.
Results: Significant differences were found between the type IIA PAS patients and controls in terms of DSCT measurements in the trachea (0.51 ± 0.32 cm2/m2 vs. 0.92 ± 0.18 cm2/m2, P < 0.001); left main bronchus (0.29 ± 0.14 cm2/m2 vs. 0.43 ± 0.18 cm2/m2, P = 0.01); right intermediate bronchus [BB in patients] (0.36 ± 0.13 cm2/m2 vs. 0.47 ± 0.12 cm2/m2, P = 0.02); and subcarinal angle [subpseudocarinal angle in patients] (116.27 ± 16.45° vs. 79.41 ± 15.71°, P < 0.001). Receiver operating characteristic analysis further revealed that these parameters may be indicators to differentiate tracheobronchial anomalies due to type IIA PAS from controls (AUC, 0.88-0.98; sensitivity, 81.7%-100%; specificity, 91.7%-100%).
Conclusions: DSCT is an alternative technique to detect tracheobronchial anomalies in pediatric patients with type IIA PAS. It can provide accurate anatomic details for surgeons to determine therapeutic strategies.
Keywords: Dual-source CT; Pulmonary artery sling; Tracheobronchial anomaly.
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