Endoscopy for the initial suspicion of vascular rings in tracheoesophageal compressions: correlation with surgical findings.

摘要

Vascular rings (VR) may produce extrinsic compression of trachea and/or esophagus. Diagnosis relies on nonspecific clinical data from resulting compression and image studies, mainly angiography, computed tomography, and cardiovascular MRI. Because of their low incidence, diagnosis is often missed. The role of bronchoscopy and esophagoscopy is controversial, but these procedures might establish for the first time the diagnostic suspicion of VR. This communication was aimed to determine to what extent endoscopic manifestations lead the clinician to suspect the presence of a VR and, moreover, to define their correlation with surgical findings.METHODS: Children with endoscopic diagnosis of VR submitted to surgery were retrospectively analyzed. RESULTS: Twenty patients fulfilled inclusion criteria. They were submitted to 19 bronchoscopies and 16 esophagoscopies, and in 60% cases they raised the first suspicion of VR. Diagnostic agreement of the type of VR between endoscopy and surgery was 85%. Bronchoscopy diagnosed 12 VR, and in 10 cases predicted the specific type of VR. Additional relevant findings were detected in nine patients (47.4%). Esophagoscopy diagnosed VR in 14 patients, predicted the specific type in 78.6% and detected all aberrant right subclavian artery cases. CONCLUSIONS: Initial suspicion of VR was raised by bronchoscopic and/or esophagoscopic findings in 60% cases. Endoscopy proved to be a valuable tool to anticipate the type of malformation and to disclose associated abnormalities.