Double aortic arch

Case contributed by Dr Mostafa Mahmoud El Feky

Presentation

Dyspnea, low oxygen saturation.

Patient Data

Age: 4 months
Gender: Male
CT

CT chest

Double aortic arch with patent lumen, completely encircling the trachea and esophagus (complete vascular ring). The right arch is slightly higher and larger than the left one measuring 8 mm and 6 mm respectively. No evidence of atretic segment.

The right arch gives off the right common carotid and right subclavian arteries while the left arch gives off the left common carotid and left subclavian arteries. This is associated with severe segmental luminal narrowing of the supra-carinal trachea; about 12 mm in length with residual luminal diameter about 1.2 mm mounting to 80% diameter stenosis. The rest of tracheobronchial tree is unremarkable.

CT

Annotated and 3D images

Double aortic arch, encircling the trachea and esophagus with 80% luminal narrowing of supra-carinal trachea.

Case Discussion

First, the pediatrician performed bronchoscopy that revealed thoracic tracheal narrowing by more than 80% and the possibility of a vascular ring was primarily considered that revealed clearly on contrast enhanced CT. Double aortic arch is the most common symptomatic type of aortic arch variant and vascular rings. Both the trachea and esophagus are encircled. Respiratory symptoms are common in infancy. Right arch dominance is the most common accounting for 80% of cases as in this case.

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Case information

rID: 54668
Case created: 21st Jul 2017
Last edited: 8th Aug 2017
Systems: Vascular, Chest
Inclusion in quiz mode: Included

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