This document summarizes a medical report for a 7 month old female patient presenting with recurrent respiratory infections. Imaging findings include bronchopneumonia, a wide upper mediastinum, and stenosis of the lower trachea. Further CT scans revealed the patient has a right-sided double aortic arch, which is compressing the lower trachea and esophagus. The diagnosis is a right-sided double aortic arch, which is a rare congenital condition where two aortic arches form a vascular ring compressing the airways.

1. Imaging Department
Jan 1 0 th
, 20 1 3
Reported by Dr. Giang

2.  Name: Le Quynh Lam
 Sex: Female
 Age: 7 months old
 Dept: Infectious Diseases Dept

3. Clinical
 Recurrent respiratory infections (bronchopneumonia
2 times/ 2 months)
 Noisy breathing: stridor & wheeze
 Persistent cough, choking

4. Chest Xrays
 Broncho-pneumonia .
 Wide upper mediastinum ( thymus gland ??? )

5. Echocardiography
 Heart structure: normal
 Right-side aortic arch

6. Tracheoscopy
Lower part of trachea: Stenosis

7. Chest CT Findings
(Pre C+)
 Upper part of trachea: normal ( AP: 7mm)
 Lower part of trachea: stenosis (AP: 3mm)
 Carina level : normal

8. Chest CT Findings
(Post C+)
 Double aortic arch : Right & Left branch of arch compress the
lower of Trachea & Esophagus
 Each arch give common carotid & subclavian artery
 Aortic arch & Descending aorta: right-side of trachea

9. Chest CT Findings
(Post C+, lung parenchyma)
 Consolidation at both lung hilum. ( broncho-pneumonia)

10. Diagnosis
Right-side double aortic arch

11. Background of Double Ao.arch
 Terminology: DAA is an anormaly of the aortic arch in which two aortic
arches form a complete vascular ring that can compress
the trachea and/or esophagus.
 Epidemiology: 0.5-1% of all congenital cardiovascular malformations.
 Age: Present soon after birth. M:F = 1:1
 Cause: Associate with chromosome 22q11 deletion (CATCH 22)
 Symtoms: Airway compressed:
 Wheeze, stridor, worsening with feeding
 Recurrent respiratory infection, apneic attacks, severe cough, cyanosis.

12. Background of Tuberous Sclerosis
 Associated abnormalities:
 Typically an isolated lesion without associated abnormalities: 80%
 20% : associated with congenital heart disease ( TOF, VSD, PDA...)
 Pathologic & Surgical features:
1. Dominal (larger) right arch, left descending aorta: 75%
2. Dominal left arch, right descending aorta: 20%
3. Arches equal in size: 5%
 Treament:
Thoracotomy with division of smaller of 2 arches, atretic
segments & ligament arteriosum.