Micro-CT of tracheal stenosis in trisomy 21

Susan C Shelmerdine,Michael T Ashworth,Nagarajan Muthialu,Alistair D Calder,Owen J Arthurs

doi:10.1136/thoraxjnl-2018-212966

Abstract

A male infant with trisomy 21, born at 36 weeks' gestation, had care withdrawn at 2 months of age and was referred for postmortem investigations. The child had been ventilator...

Highlights

The trachea was prepared using a solution of formalin and potassium iodide, and imaged at a resolution of 28 microns (0.028 mm). This was performed on a Med-X Alpha micro‐CT scanner (Nikon Metrology, Tring, UK) with a molybdenum target and no additional filtering
Imaging revealed multiple complete and bifid tracheal rings throughout the level of the stenosis, with associated areas of mucosal ulceration and tracheal wall fibrosis, the latter believed to result from prolonged ventilation and resultant tissue granulation
Congenital tracheal stenosis is a rare airway anomaly estimated to occur in approximately 1 in 64 500 births, with several small case series reporting an association with trisomy 21.2 It is characterised by complete tracheal rings and, over 60% have complex cardiac anomalies

Summary

Introduction

The trachea was prepared using a solution of formalin and potassium iodide, and imaged at a resolution of 28 microns (0.028 mm). This was performed on a Med-X Alpha micro‐CT scanner (Nikon Metrology, Tring, UK) with a molybdenum target and no additional filtering. Imaging revealed multiple complete and bifid tracheal rings throughout the level of the stenosis, with associated areas of mucosal ulceration and tracheal wall fibrosis, the latter believed to result from prolonged ventilation and resultant tissue granulation.

Results

Conclusion