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Standard methods to evaluate tracheal pathology in children, including bronchoscopy, may require general anesthesia. The study describes a technique for unsedated dynamic volumetric computed tomography angiography (DV‐CTA) of the proximal airway and surrounding vasculature in children and evaluate its performance compared to the reference‐standard of rigid bronchoscopy. Over 19 months, the study identified 32 children (median age 8 months, range 3–14 months) who had undergone DV‐CTA and bronchoscopy within 90 days of each other. There was excellent agreement between DV‐CTA and bronchoscopy for diagnosis of tracheomalacia (κ = 0.81, p < 0.001), which improved if children (n = 25) had the studies within 30 days of each other (κ = 0.91, p < 0.001). In addition, CTA provided incremental information on severity, and cause of secondary tracheomalacia. For most children, DV‐CTA requires no sedation or respiratory manipulation and correlates strongly with bronchoscopy for the diagnosis of tracheomalacia.
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