Presentation
Stridor
Patient Data
A soft tissue shadow is seen on the right side of the tracheal air column., and an abrupt narrowing with a tapering lower end is also noted in the tracheal air.
A double aortic arch is noted. The right arch is dominant, and the left arch is hypoplastic. The right arch gives origin to the right common carotid and right subclavian arteries, while the left arch gives origin to the left common carotid and left subclavian arteries. A diverticulum is seen protruding from the proximal descending aorta towards the hypoplastic left arch without joining it. The trachea and oesophagus are markedly compressed between the diverticulum and the right arch.
The right arch gives origin to:
The left arch gives origin to:
The diverticulum arising from the proximal descending aorta is tethered towards the left-sided arch.
There is a noticeable narrowing of the tracheal air column at the site of compression.
Case Discussion
Vascular ring anomalies are one of the causes of paediatric stridor. This is a case of an incomplete double aortic arch causing marked narrowing of the trachea and oesophagus. An incomplete double aortic arch is an uncommon cause of symptomatic vascular ring. There was a suspected presence of a retro-oesophageal ligamentum arteriosum based on the tethering of the diverticulum towards the hypoplastic left arch. During the operation, the hypoplastic left-sided arch was identified, and the retro-oesophageal ligamentum arteriosum was confirmed as the cause of significant compression. Surgical resection of the ligamentum arteriosum was done, and the patient improved in the following days.
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