Vascular rings and slings refer to the congenital vascular encirclement of the esophagus and/or trachea by anomalous/aberrant vessels.
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Epidemiology
Vascular rings are rare, occurring in <1% of patients 1. No gender or ethnic predispositions have been identified 3.
Clinical presentation
Many vascular rings and slings are asymptomatic although they can present in pediatric patients with wheezing/stridor, recurrent respiratory infections, and/or dysphagia lusoria.
Pathology
Vascular rings can be classified as complete (mostly symptomatic) or incomplete (mostly asymptomatic) 5.
Etiology
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
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aberrant right subclavian artery (most common)
not considered a complete vascular ring
usually asymptomatic
Associations
Radiographic features
Radiographic features will differ depending on the underlying anomaly.
Plain radiograph
Abnormal contour to the trachea may be visible on plain film, as may a right-sided aortic arch.
Fluoroscopy
On contrast esophagogram (and air tracheogram), the pattern of indentations on the frontal and lateral views helps to narrow the differential:
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anterior esophageal indentation, posterior tracheal indentation
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posterior esophageal indentation, tracheal buckling to the right
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posterior esophageal indentation, tracheal buckling to the left
aberrant left subclavian artery with right aortic arch
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anterior tracheal indentation in infants
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posterior and bilateral esophageal indentation, anterior and bilateral tracheal indentation
CT/MRI
allow precise demonstration of the anomaly
Differential diagnosis
Possible considerations include:
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