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Virtual Pediatric Hospital: Thoracopaedia: An Imaging Encyclopedia of Pediatric Thoracic Disease: Case 59 Thoracopaedia: An Imaging Encyclopedia of Pediatric Thoracic Disease

Case 59

Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed

Chief Complaint:
Three month old female with increasing respiratory distress.

Clinical History:
The patient was a 3 month old female with Downs Syndrome and a ventricular septal defect who had increasing respiratory difficulties that culminated in a respiratory arrest. At that time, she was found to be difficult to intubate at an outside hospital. She was successfully resuscitated and transferred to our institution for further investigation.

Clinical Physical Exam:
Respiratory distress.

Clinical Labs:

Clinical Differential Diagnosis:
Tracheal stenosis

Imaging Findings:
A neck CT exam showed narrowing of the trachea.

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Imaging Differential Diagnosis:
Tracheal stenosis

Operative Findings:
Bronchoscopy performed after the neck CT exam showed a stenosis of the mid trachea with the tracheal lumen being less than 2 mm in diameter at that point. The patient was taken electively to the operating room and the stenotic area of trachea was resected and the ends reanastomosed.

Pathological Findings:

Final Diagnosis:
Tracheal Stenosis

Follow-up and Prognosis:
The patient had a complicated post-operative course with multiple tracheal dilations required due to restenosis of the trachea at the anastomotic site.

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