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Disorders of the Mediastinum |

Airway Obstruction by Innominate Artery Compression of the Trachea: A Rare Case in an 82-Year-Old Female With Dyspnea and Stridor

Anna Kyu Chen, MD; Mohammad Zalt, MD; Saurabhkumar Patel, MD
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St John Hospital Medical Center, Harper Woods, MI


Chest. 2015;148(4_MeetingAbstracts):419A. doi:10.1378/chest.2267549
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Abstract

SESSION TITLE: Disorders of the Mediastinum Student/Resident Case Report Posters

SESSION TYPE: Student/Resident Case Report Poster

PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM

INTRODUCTION: Tracheal stenosis causing airway obstruction by extrinsic compression of innominate artery is uncommon in adult population. To our knowledge, this is the first ever reported case of innominate arteriopexy in an elderly in the literature.

CASE PRESENTATION: An 82-yo female with PMHx of CAD and HTN presented with non-productive cough, progressive dyspnea and inspiratory stridor for 2 months. A flexible bronchoscopy showed a severe obstruction of proximal trachea. The obstruction presented with inward bulging of both lateral and posterior wall of trachea and was therefore assumed to be secondary to extrinsic compression. A CT w/ contrast and angiography of neck showed a compression of the proximal trachea by tortuous innominate artery causing right tracheal deviation. Due to the severity of the stenosis with impending airway compromise and concern of developing tracheomalacia, patient successfully underwent ligation of the tortuous innominate artery proximally and distally to the trachea with primary reanastomosis.

DISCUSSION: Compromised airway obstruction due to innominate artery compression of trachea is rare in adults as the development of the trachea’s cartilaginous and the growth of the aortic arch makes the innominate artery away from the trachea after age of 2. A respiratory obstruction owing to tracheomalacia can occur when weaken wall of trachea collapses. Diagnostic modalities include flexible bronchoscopy, CT contrast and angiography, and MRI to assess vascular malformations and peripheral structures in mediastinum. Medical management is conservative, while surgical options consist of arteriopexy, with innominate artery suspension to sternum or by pericardial ‘hammock’, and reimplantation onto proximal aortic arch. To our knowledge, a case of innominate arteriopexy performed in an elderly has never been reported in the literature. In our case, we considered the cause to be a multifactorial including patient’s known atherosclerotic and hypertensive disease may have accelerated the underlying mild innominate artery malformation into torturous vessel that lead to tracheal compression. Surgical intervention was most appropriate in our patient due to marked stenosis of the trachea and the anatomy of the innominate artery. Innominate artery compression of the trachea is a potentially curable cause of extrinsic airway obstruction.

CONCLUSIONS: We report the first case of innominate arteriopexy performed in an elderly. Innominate artery compression of the trachea is a potentially curable cause of extrinsic airway obstruction.

Reference #1: Choi RMC, Yoon JS. Airway obstruction by extrinsic tracheal compression during spinal surgery under prone position. Korean J Anesth 2010;59:S45-48

Reference #2: Habboushe J, Gerolemou LN. A case of an anomalous innominate artery causing tracheal compression in an adult, misdiagnosed as COPD. CHEST 2009;136

Reference #3: Sato E, Koyama, S. Respiratory distress due to tracheal compression by the dilated innominate artery. Eur Respir J 1999;14:723-724

DISCLOSURE: The following authors have nothing to disclose: Anna Kyu Chen, Mohammad Zalt, Saurabhkumar Patel

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