DIAGNOSIS AND MANAGEMENT OF LEFT MAIN STEM BRONCHUS COMPRESSION

There are four major variants of congenital vascular tracheal compress ion: innominate artery, aberrant subclavian, aorta or aortic arch anom aly, and pulmonary artery sling. These forms of vascular compression t ypically involve the trachea and/or the right main stem bronchus. We p resent eight cases of congenital vascular compression involving the le ft main stem bronchus. These cases represent a poorly understood varia nt of vascular tracheal compression. This variant represents approxima tely 10% of our pediatric tracheobronchial compression or stenosis pat ients. The finding, both noted endoscopically and now illustrated by m agnetic resonance imaging, is caused by compression of the left main s tem bronchus between the descending aorta and a portion of the pulmona ry artery. Frequently, the descending aorta is in an abnormal anterior position with relation to the thoracic spine. Recognition of this ent ity is important in our experience and has influenced clinical managem ent. In four of eight children, it required a surgical procedure direc ted toward the relief of the left main stem compression.