Skip to main content Accessibility help

Bronchoscopy versus multi-detector computed tomography in the diagnosis of congenital vascular ring

  • A H Gaafar (a1) and K I El-Noueam (a2)



Vascular rings are congenital vascular anomalies of the aortic arch complex which cause compression of the trachea and/or oesophagus. A variety of investigations may lead to diagnosis of these anomalies, including bronchoscopy and computed tomography. During the latter, image acquisition and processing use the multi-detector row technique and new reconstruction algorithms, producing high-resolution images which can be visualised as complex, three-dimensional renditions.


This study aimed to assess and compare the roles of bronchoscopy and multi-detector row computed tomography in the diagnosis of congenital vascular ring.

Patients and methods:

We included infants and children below the age of 16 years who presented with congenital vascular ring. All patients underwent rigid bronchoscopy under general anaesthesia, with spontaneous respiration. All computed tomography scans were obtained using a 16 multi-detector row computed tomography system, followed by data reconstruction on a three-dimensional workstation.


Ten patients with congenital vascular ring were identified (six boys and four girls). Fifty per cent of cases presented within the first year of life. Double aortic arch was the most common anomaly (40 per cent). Bronchoscopy detected external tracheal compression in nine cases (90 per cent). Associated airway lesions were detected endoscopically in three cases. In contrast, multi-detector row computed tomography detected the vascular ring in all cases, with accurate detection of the compressing vessel; however, it did not detect any associated airway lesions.


Bronchoscopy and radiological evaluation are essential for the diagnosis and pre-operative evaluation of congenital vascular ring. Multi-detector row computed tomography can provide more information about the nature of the disease, and can facilitate better communication between clinicians, compared with conventional computed tomography.


Corresponding author

Address for correspondence: Dr Alaa Gaafar, Assistant Professor, Department of Otolaryngology – Head and Neck Surgery, Alexandria Faculty of Medicine, Champollion st., El-Azareta, no. 21131, Alexandria, Egypt E-mail:


Hide All
1Kaiser, LR, Kron, IL, Spray, TL, eds. Mastery of Cardiothoracic Surgery. Philadelphia: Lippincott-Raven, 1998
2Shields, TW, LoCicero, JI, Ponn, RB, eds. General Thoracic Surgery. Philadelphia: Lippincott Williams & Wilkins, 2000
3Woods, RK, Sharp, RJ, Holcomb, GW. Vascular anomalies and tracheoesophageal compression: a single institution's 25-year experience. Ann Thorac Surg 2002;72:434–9
4Turner, A, Gavel, G, Coutts, J. Vascular rings – presentation, investigation and outcome. Eur J Pediatr 2005;164:266–70
5Bonnard, A, Auber, F, Fourcade, L, Marchac, V, Emond, S, Révillon, Y. Vascular ring abnormalities: a retrospective study of 62 cases. J Pediatr Surg 2003;38:539–43
6O'Connor, TE, Cooney, T. Oesophageal foreign body and a double aortic arch: rare dual pathology. J Laryngol Otol 2009;123:13
7Jones, DT, Jonas, RA, Healy, GB. Innominate artery compression of the trachea in infants. Ann Otol Rhinol Laryngol 1994;103:347–50
8Turkvatan, A, Buyukbayraktar, FG, Olçer, T, Cumhur, T. Congenital anomalies of the aortic arch: evaluation with the use of multidetector computed tomography. Korean J Radiol 2009;10:176–84
9Alkadhi, H, Wildermuth, S, Desbiolles, L. Vascular emergencies of the thorax after blunt and iatrogenic trauma multi-detector row CT and three-dimensional imaging. Radiographics 2004;24:1239–55
10Kriklin, JW. Vascular ring and sling. In: Kriklin, JW, Barratt Boyes, BG, eds. Cardiac Surgery. New York: Churchill Livingstone, 1993;1365–82
11Bakker, DA, Berger, RM, Wistenburg, M, Bogers, AJ. Vascular rings: a rare cause of common respiratory symptoms. Acta Pediatr 1999;88:947–52
12Tuo, G, Volpe, P, Bava, GL. Prenatal diagnosis and outcome of isolated vascular rings. Am J Cardiol 2009;103:416–19
13Andreas, G, Reinhold, P, Micheal, R, Beate, N. Vascular ring causing tracheal compression in an adult patient. Ann Thorac Surg 2003;75:1959–60
14Ruzmetov, M, Vijay, P, Rodefeld, MD, Turrentine, MW, Brown, JW. Follow-up of surgical correction of aortic arch anomalies causing tracheoesophageal compression: a 38-year single institution experience. J Pediatr Surg 2009;44:1328–32
15Backer, CL, Ilbawi, MN, Idriss, FS, DeLeon, SY. Vascular anomalies causing tracheoesophageal compression. Review of experience in children. J Thorac Cardiovasc Surg 1989;97:725–31
16Cakir, E, Ersu, RH, Uyan, ZS, Oktem, S, Karadag, B. Flexible bronchoscopy as a valuable tool in the evaluation of persistent wheezing in children. Int J Otorhinolaryngol 2009;73:1666–8
17Lawler, LP, Fishman, EK. Multi-detector row CT of thoracic disease with emphasis on 3D volume rendering and CT angiography. Radiographics 2001;21:1257–73
18Sinclair, DS. Traumatic aortic injury: an imaging review. Emerg Radiol 2002;9:1320
19Gotway, MB, Dawn, SK. Thoracic aorta imaging with multislice CT. Radiol Clin North Am 2003;41:521–43
20Lee, EY, Siegel, MJ, Hildebolt, CF, Gutierrez, FR, Bhalla, S, Fallah, JH. MDCT evaluation of thoracic aortic anomalies in pediatric patients and young adults: comparison of axial, multiplanar, and 3D images. AJR Am J Roentgenol 2004;182:777–84
21Mirvis, SE. Thoracic vascular injury. Radiol Clin North Am 2006;44:181–97
22Yusuf, KY, Ersin, E, Esce, S. A rare cause of respiratory distress in infants: tracheal compression due to anomalous course of innominate artery. Turk J Ped 2006;48:93–5
23Adler, SC, Isaacson, G, Balsara, RK. Innominate artery compression of the trachea: diagnosis and treatment by anterior suspension. A 25-year experience. Ann Otol Rhinol Laryngol 1995;59:526–8



Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed