Joshua A. Stramiello, Tzyynong L. Friesen, Aparna Rao, Kanishka Ratnayaka, John Moore, Howaida El-Said, Matthew T. Brigger
University of California San Diego. Rady Children’s Hospital San Diego.
United States
International Journal of Pediatric Otorhinolaryngology
Int J Pediatr Otorhinolaryngol 2022;
DOI: 10.1016/j.ijporl.2022.111123
Abstract
Objective: To report a single-institution’s experience of symptomatic aortopulmonary collaterals presenting as tracheostomy tube hemorrhage.
Study design: Retrospective case series and Contemporary Review.
Setting: Tertiary care children’s hospital.
Methods: Retrospective review, from 2015 to 2020, of patients <18 years old who were treated for tracheostomy hemorrhage with endovascular embolization of aortopulmonary collateral (APC) vessels.
Results: 4 patients were identified, 2 males and 2 females, ages 15 months-to 14 years-old, with a range of cyanotic congenital heart diseases. Direct laryngoscopy and bronchoscopy were necessary for excluding proximal airway sources. Chest computed tomography angiography did not localize pulmonary hemorrhage, but helped identify aortopulmonary collaterals. Cardiac catheterization was both diagnostic and therapeutic with use of endovascular embolization techniques by pediatric interventional cardiology and interventional radiology. Previously reported APC-related pulmonary hemorrhages occurred in significantly different settings compared to our patients, and evaluation by an otolaryngologist was key to rule out upper airway etiologies.
Conclusion: Symptomatic aortopulmonary collaterals is an important etiology in pediatric tracheostomy tube hemorrhage in patients with cyanotic congenital heart disease.
Category
Abnormal Systemic to Pulmonary Arterial Collaterals or Connections
Symptoms and Findings Associated with Pulmonary Vascular Disease
Surgical and Catheter-mediated Interventions for Pulmonary Vascular Disease
Age Focus: Pediatric Pulmonary Vascular Disease
Fresh or Filed Publication: Filed (PHiled). Greater than 1-2 years since publication
Article Access
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