Vascular rings are rare, occurring in <1% of patients 1. No gender or ethnic predispositions have been identified 3.
Vascular rings can be classified as complete (mostly symptomatic) or incomplete (mostly asymptomatic) 5.
Causes of vascular rings and slings commonly include 1:
- double aortic arch (the most common symptomatic vascular ring)
- right aortic arch with aberrant left subclavian artery and left ligamentum arteriosum
aberrant right subclavian artery (most common)
- not considered a complete vascular ring
- usually asymptomatic
- pulmonary sling
Radiographic features will differ depending on the underlying anomaly.
Abnormal contour to the trachea may be visible on plain film, as may a right sided aortic arch.
On contrast esophagram (and air tracheogram), the pattern of indentations on the frontal and lateral views helps to narrow the differential:
- anterior esophageal indentation, posterior tracheal indentation
- posterior esophageal indentation, tracheal buckling to the right
- posterior esophageal indentation, tracheal buckling to the left
- aberrant left subclavian artery with right aortic arch
- anterior tracheal indentation in infants
- posterior and bilateral esophageal indentation, anterior and bilateral tracheal indentation
- allow precise demonstration of the anomaly
Possible considerations include:
- 1. Pediatric Radiology (Rotations in Radiology). Oxford University Press. ISBN:0199755329. Read it at Google Books - Find it at Amazon
- 2. Etesami M, Ashwath R, Kanne J et-al. Computed tomography in the evaluation of vascular rings and slings. Insights Imaging. 2014;5 (4): 507-21. doi:10.1007/s13244-014-0343-3 - Free text at pubmed - Pubmed citation
- 3. Türkvatan A, Büyükbayraktar FG, Olçer T et-al. Congenital anomalies of the aortic arch: evaluation with the use of multidetector computed tomography. Korean J Radiol. 2009;10 (2): 176-84. doi:10.3348/kjr.2009.10.2.176 - Free text at pubmed - Pubmed citation
- 4. Berdon WE. Rings, slings, and other things: vascular compression of the infant trachea updated from the midcentury to the millennium-the legacy of Robert E. Gross, MD, and Edward B. D. Neuhauser, MD. Radiology. 2000;216 (3): 624-32. doi:10.1148/radiology.216.3.r00se40624 - Pubmed citation
- 5. O'Brien WT. Top 3 Differentials in Radiology. Thieme. (2009) ISBN:1604062266. Read it at Google Books - Find it at Amazon
- 6. Schuster T, Hecker WC, Ring-Mrozik E et-al. Tracheal stenosis by innominate artery compression in infants: surgical treatment in 35 cases. Prog Pediatr Surg. 1991;27: 231-43. Pubmed citation