Vascular ring: Difference between revisions
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==Background== | ==Background== | ||
* | * Congenital anatomic abnormalities of the aortic arch --> compression of the trachealbronchial tree and esophagus --> respiratory and GI symptoms. | ||
* Accounts for 1-3 of congenital heart disease | * Accounts for 1-3 of congenital heart disease | ||
* Males | * Males have double the risk compared to females | ||
==Clinical Features== | ==Clinical Features== | ||
*Stridor | *[[Stridor (Peds)|Stridor]] | ||
*Respiratory infections | *Respiratory infections | ||
*Respiratory distress | *[[Respiratory distress]] | ||
*Wheezing | *[[Wheezing]] | ||
*Cough | *[[Cough]] | ||
*Less common | *Less common | ||
**Dysphagia | **[[Dysphagia]] | ||
**Feeding difficulty | **Feeding difficulty | ||
**Vomiting | **[[Nausea and vomiting (peds)|Vomiting]] | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Pediatric stridor DDX}} | |||
==Evaluation== | ==Evaluation== | ||
*Unlikely to be definitively diagnosed in ED | |||
*[[CXR]] | |||
**Not sensitive, but good place to start | |||
*Barium esophagography | |||
*[[Echocardiography]] | |||
*Bronchoscopy, cardiac catheterization | |||
==Management== | ==Management== | ||
*Surgical management for all symptomatic patients | |||
==Disposition== | ==Disposition== | ||
*Admit if symptomatic or new diagnosis | |||
==See Also== | ==See Also== | ||
*[[Stridor (Peds)]] | |||
*[[Stridor]] | |||
*[[Congenital heart disease]] | |||
==References== | ==References== | ||
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[[Category:Vascular]] | [[Category:Vascular]] | ||
[[Category:Cardiology]] | [[Category:Cardiology]] | ||
[[Category:Pediatrics]] | |||
Revision as of 19:57, 11 August 2017
Background
- Congenital anatomic abnormalities of the aortic arch --> compression of the trachealbronchial tree and esophagus --> respiratory and GI symptoms.
- Accounts for 1-3 of congenital heart disease
- Males have double the risk compared to females
Clinical Features
- Stridor
- Respiratory infections
- Respiratory distress
- Wheezing
- Cough
- Less common
Differential Diagnosis
Pediatric stridor
<6 Months Old
- Laryngotracheomalacia
- Accounts for 60%
- Usually exacerbated by viral URI
- Diagnosed with flexible fiberoptic laryngoscopy
- Vocal cord paralysis
- Stridor associated with feeding problems, hoarse voice, weak and/or changing cry
- May have cyanosis or apnea if bilateral (less common)
- Subglottic stenosis
- Congenital vs secondary to prolonged intubation in premies
- Airway hemangioma
- Usually regresses by age 5
- Associated with skin hemangiomas in beard distribution
- Vascular ring/sling
>6 Months Old
- Croup
- viral laryngotracheobronchitis
- 6 mo - 3 yr, peaks at 2 yrs
- Most severe on 3rd-4th day of illness
- Steeple sign not reliable- diagnose clinically
- Epiglottitis
- H flu type B
- Have higher suspicion in unvaccinated children
- Rapid onset sore throat, fever, drooling
- Difficult airway- call anesthesia/ ENT early
- H flu type B
- Bacterial tracheitis
- Rare but causes life-threatening obstruction
- Symptoms of croup + toxic-appearing = bacterial tracheitis
- Foreign body (sudden onset)
- Marked variation in quality or pattern of stridor
- Retropharyngeal abscess
- Fever, neck pain, dysphagia, muffled voice, drooling, neck stiffness/torticollis/extension
Evaluation
- Unlikely to be definitively diagnosed in ED
- CXR
- Not sensitive, but good place to start
- Barium esophagography
- Echocardiography
- Bronchoscopy, cardiac catheterization
Management
- Surgical management for all symptomatic patients
Disposition
- Admit if symptomatic or new diagnosis