Vascular ring: Difference between revisions

Latest revision as of 18:52, 26 September 2019

Background

Congenital anatomic abnormalities of the aortic arch
- Compression of the trachealbronchial tree and esophagus
- Leads to respiratory and GI symptoms.
Accounts for 1-3 of congenital heart disease
Male:Female 2:1

Clinical Features

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
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

References

Authors:

@@ Line 1: / Line 1: @@
-'''Background'''
+==Background==
-* Characterize by anatomical/congenital abnormalities of the aortic arch leading to compression of the trachealbronchial tree and esophagus causing respiratory and GI symptoms.
+*Congenital anatomic abnormalities of the aortic arch
-* Accounts for 1-3 of congenital heart disease
+**Compression of the trachealbronchial tree and esophagus
-* Males are at x2 risk than females
+**Leads to respiratory and GI symptoms.
+*Accounts for 1-3 of congenital heart disease
+*Male:Female 2:1
--------------------------------------------------------------------------------
+==Clinical Features==
-'''Presenting symptoms'''
+*[[Stridor (Peds)|Stridor]]
-●Stridor
+*[[Pneumonia (peds)|Respiratory infections]]
-●Respiratory infections
+*[[Shortness of breath (peds)|Respiratory distress]]
-●Respiratory distress
+*[[Wheezing]]
-●Wheezing
+*[[Cough]]
-●Cough
+*Less common
-Less common
+**[[Dysphagia]]
-●Dysphagia
+**[[Failure to thrive (peds)|Feeding difficulty]]
-●Feeding difficulty
+**[[Nausea and vomiting (peds)|Vomiting]]
-●Vomiting
-------------------------------------------------------------------------------
-'''Workup'''
-------------------------------------------------------------------------------
+==Differential Diagnosis==
-'''Management'''
+{{Pediatric stridor DDX}}
------------------------------------------------------------------------------
-'''Disposition'''
----------------------------------------------------------------------------
+==Evaluation==
+*Unlikely to be definitively diagnosed in ED
+*[[CXR]]
+**Not sensitive, but good place to start
+*Barium esophagography
+*[[Echocardiography]]
+*Bronchoscopy, cardiac catheterization
-'''Author'''
+==Management==
-Obed Barrera Adame MS4
+*Surgical management for all symptomatic patients
+==Disposition==
+*Admit if symptomatic or new diagnosis
+==See Also==
+*[[Stridor (Peds)]]
+*[[Stridor]]
+*[[Congenital heart disease]]
+==References==
+<references/>
+[[Category:Vascular]]
+[[Category:Cardiology]]
+[[Category:Pediatrics]]