Double aortic arch presenting as severe bronchiolitis in a 2‐week‐old infant

Abstract

A 2-week-old female infant was transferred from a regional hospital for mechanical ventilation after developing severe respiratory distress. Stridor had been present since the age of 1 week and was complicated by coryzal illness. Mechanical ventilation was difficult with marked inspiratory and expiratory flow obstruction recorded by the ventilator. Echocardiogram showed a normal heart. Flexible bronchoscopy revealed mid-tracheal extrinsic compression (unchanged with positive end-expiratory pressure) and advancement of the endotracheal tube by 2 cm completely corrected the flow obstruction. Repeat echocardiogram showed a double aortic arch. This case report emphasizes the importance of clinical history, examination findings and interpretation of the ventilator waveforms in the differential diagnosis of a difficult-to-ventilate infant with bronchiolitis.

Double aortic arch presenting as neonatal respiratory failure in the delivery room

“…Although respiratory symptoms are reported in the neonatal period, critical tracheal compression leading to respiratory failure immediately after birth is a rare manifestation of double aortic arch. [3][4][5] Nevertheless, this can provide a diagnostic and therapeutic dilemma, owing to a widely held and generally correct notion that respiratory failure is not a typical manifestation of the disease in the immediate neonatal period. In one series of 81 children, surgical repair was necessary at a median age of 6 months, with the youngest patient repaired at 3 days of life.…”

Early Lung Function Testing in Infants with Aortic Arch Anomalies Identifies Patients at Risk for Airway Obstruction

“…Likewise, a RAAA, together with the ligamentum arteriosum (the remnant of the ductus arteriosus Botalli) may also cause compression of the mediastinal structures by forming a so called aortic sling. Therefore, both anomalies may cause stridor, cough, dyspnoea, dysphagia and recurrent lower airway infections [6], [7], [8], [9]. Based on surgical series, DAAA are the most common causes of vascular rings, followed by a right aortic arch with an aberrant left subclavian and left ductal ligament [10].…”