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A 7 month old female child presented with recurrent respiratory infections, noisy breathing, and persistent coughing. Imaging revealed a right-sided double aortic arch compressing the lower trachea. A tracheoscopy also found stenosis in the lower trachea. The diagnosis was confirmed to be a right-sided double aortic arch by chest CT scans. This is a congenital abnormality where two aortic arches form a vascular ring compressing the trachea and/or esophagus. Surgical division of the smaller arch is typically required to treat symptoms of airway compression.
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Gb quai đmc doi
- 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 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.
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