Double Aortic Arch Masquerading as Asthma for Thirty Years

Stoica, Șerban; Lockowandt, Ulf; Coulden, Richard; Ward, R. Parker; Bilton, Diana; Dunning, John

doi:10.1159/000049378

Cited by 21 publications

(13 citation statements)

References 10 publications

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“…DAA is usually diagnosed in infancy or early childhood, but occasionally the diagnosis is delayed for years. There are several reports of DAA masquerading as long-standing asthma, both in children (14)(15)(16) and in adults (17)(18)(19)(20)(21). Occasionally, DAA may simulate exercise-induced asthma (22,23).…”

Section: Discussionmentioning

confidence: 99%

Ground zero: not asthma at all

Benedictis

Mirabile

et al. 2015

Pediatric Allergy Immunology

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Upper airway obstruction is commonly misdiagnosed as asthma. We report on four children with recurrent respiratory symptoms who had been erroneously diagnosed as having asthma and who received anti-asthma medication for several years. The evaluation of spirometry tracing was neglected in all cases. Subglottic stenosis, tracheomalacia secondary to tracheo-esophageal fistula, double aortic arch, and vocal cord dysfunction were suspected by direct inspection of the flow-volume curves and eventually diagnosed. The value of clinical history and careful evaluation of spirometry tracing in children with persistent respiratory symptoms is critically discussed.

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Section: Discussionmentioning

confidence: 99%

Ground zero: not asthma at all

Benedictis

Mirabile

et al. 2015

Pediatric Allergy Immunology

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“…DAA is diagnosed by means of CT, magnetic resonance imaging and aortography. Recently, 3D-CT is reported to be more useful for the diagnosis of DAA than other modalities [14]. The only therapy for DAA is operation, decompressing bronchus and esophagus by dividing the non-dominant arch [10,15].…”

Section: Discussionmentioning

confidence: 99%

A Fatal Aortoesophageal Fistula Caused by Critical Combination of Double Aortic Arch and Nasogastric Tube Insertion for Superior Mesenteric Artery Syndrome

Miura¹,

Nakamura²,

Yamada³

et al. 2010

Case Rep Gastroenterol

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Double aortic arch (DAA) is a rare vascular congenital abnormality. Since a vascular ring surrounds bronchus and esophagus, any oral or nasal intubation can physically cause fatal aortoesophageal fistula (AEF). We report herein the first case of association of DAA and superior mesenteric artery (SMA) syndrome and the second case of AEF caused by nasogastric intubation in an adult with DAA. A 19-year-old woman visited our hospital for nausea and vomiting. She was diagnosed with SMA syndrome by computed tomography (CT). Nasogastric intubation relieved her symptoms in 4 days. Extramural compression with top ulceration was found in esophagogastroduodenoscopy on the 5th hospital day. She suddenly showed massive hematemesis on the 12th hospital day. AEF was found by CT. Soon, she died despite of intensive care. Retrospective interview disclosed the fact that DAA was pointed out in her childhood. We conclude that intubation must be avoided in DAA and a detailed clinical interview about DAA is mandatory to avoid AEF.

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“…Affected adults, like our case, may be asymptomatic [12][13][14] or they may present with dysphagia and/or respiratory symptoms. Late adult diagnosis may be a consequence of delayed diagnosis of established symptoms, 15 or the presentation with new symptoms. 16,17 In these situations, the late presentation has been attributed to increasing aortic size.…”

Section: Discussionmentioning

confidence: 99%

“…16,17 In these situations, the late presentation has been attributed to increasing aortic size. 17 In addition to the usual expected increases in aortic size with advancing age, 1 some patients with double aortic arch have been shown to have significant aneurysmal progression 15 that could give rise to late-onset symptoms. The natural history of asymptomatic double aortic arch diagnosed in adulthood remains unclear but development of compression may be expected as the aorta dilates with age.…”

Section: Discussionmentioning

confidence: 99%