Vascular rings and slings
Vascular rings are rare, occurring in <1% of patients 1. No gender or ethnic predispositions have been identified 3.
Many vascular rings and slings are asymptomatic although they can present in pediatric patients with wheezing/stridor, recurrent respiratory infections and/or dysphagia lusoria.
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.
This may similarly demonstrate vascular indentations on the esophagus on barium swallow. The pattern of indentations on the lateral oesophagram helps to narrow the differential:
- posterior tracheal and anterior esophageal indentation
- posterior esophageal indentation
- anterior tracheal indentation in infants
- anterior tracheal and posterior esophageal 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