A malformed blood vessel wraps around a boy’s trachea

Ho Chi Minh CityA two-month-old boy, living in Can Tho, had a blood vessel going in the opposite direction wrapped around his trachea, causing tracheal stenosis, difficulty breathing, and long-term fever.

Doctor Nguyen Minh Tien (Deputy Director of City Children’s Hospital, Ho Chi Minh City) said that the child was transferred to the emergency room from Can Tho at the end of 2021. Before the transfer, the child had a mild fever, cough, wheezing, and difficulty breathing. a week. The family took the baby to a private doctor for treatment, and was admitted to a local hospital. The doctor diagnosed the child with bronchiolitis, was treated with antibiotics, respiratory support and continuous positive pressure oxygen (CPAP). However, the respiratory failure did not improve, the child was intubated to help breathe, transferred to the City Children’s Hospital.

Here, the children were treated with anti-inflammatory antibiotics, continued to support breathing and mechanical ventilation with high machine parameters. The blood test results showed a very high severe respiratory acidosis (CO2 retention in the blood), with a CO2 (PaCO2) fractionalization of up to 86 mmHg, and a normal range of 35 to 45 mmHg, indicating that the child had severe airway obstruction. Doctors specializing in respiratory, cardiovascular, thoracic surgery, otolaryngology, etc. had urgent consultation, decided to take a CT scan to investigate the airways and large blood vessels in the chest for the child to find the cause.

CT scan image of the child’s trachea with the left pulmonary artery wrapping around the trachea, narrowing the airway, making it difficult for the child to breathe, cyanotic. Photo: provided by the doctor

The scan image shows the child’s left pulmonary artery going in the opposite direction. Instead of starting from the pulmonary artery stem and going out in front of the trachea, straight into the left lung as usual, the left pulmonary artery goes around from the right to the back of the trachea, and then to the left into the left lung. Blood vessels wrap tightly around the middle of the trachea, in some places the diameter of the trachea is only 2 mm. From there, it compresses the vascular sling, making it difficult for children to breathe for a long time, Dr. Tien said.

The child is scheduled for surgery with the help of the extracorporeal circulatory system. The surgical team opened the chest, cut out the narrow part of the trachea, and brought the left pulmonary artery in front of the trachea; connecting the two ends of the trachea in a “sliding” fashion. At the same time, the surgical team inserted a special endotracheal tube with a spring frame to keep the endotracheal tube from collapsing through the two-centimeter tracheal junction, firmly fixed the outside.

After surgery, the disease still progressed because the airways were very edematous, and the baby received intensive care, such as mechanical ventilation, sedation, muscle relaxation, aerosol breathing and many special drugs for anti-inflammatory and edema…; Nutritional supplement to support wound healing of tracheal anastomosis. Currently, after two weeks of treatment, the child has gradually improved, reduced ventilator parameters, weaned off the ventilator and breathed fresh air on his own, awake.

Doctor Tien recommends that parents when seeing their children at the age of newborns, infants (under one year old) coughing, wheezing, having trouble breathing, take them to a hospital with a specialist in pediatrics for a doctor’s examination and diagnosis. exactly. From there, the doctor has an appropriate and timely treatment plan, because in addition to common causes such as bronchiolitis, pneumonia, infant asthma… children may also suffer from diseases that are difficult to diagnose such as Blood vessels wrap around the trachea.

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