Airway compression in children with abnormal thoracic configuration

PURPOSE: To assess the clinical and imaging findings in children with severe tracheal or bronchial compression caused by abnormal thoracic configuration. MATERIALS AND METHODS: Clinical and imaging findings, care, and outcome were reviewed in six patients with airway compression caused by abnormal thoracic configuration. Radiographs and magnetic resonance (MR) images were available in all patients. RESULTS: Mechanisms of airway compression included alteration of mediastinal anatomy and direct airway compression secondary to a narrow anteroposterior chest diameter. In three patients, the trachea was compressed at the level of the thoracic inlet. In the other three patients, the left main bronchus was compressed. Four patients underwent surgery for the thoracic deformity, with resolution of airway symptoms. In all four patients, the presence, location, and cause of airway obstruction determined at MR imaging were confirmed at surgery. CONCLUSION: Abnormal thoracic configuration, in addition to causing restrictive lung disease, can cause respiratory distress secondary to severe compression of the central airways.