Double Aortic Arch Presents With Dysphagia as Initial Symptom

Abstract

A 62-year-old woman presented with breathlessness and dysphagia. Routine chest x-ray showed a widening in the upper mediastinum that suggested a thoracic aorta enlargement. No cardiomegaly was found (A). Transthoracic echocardiography revealed normal left ventricular systolic function with diastolic dysfunction and aortic sclerosis. Magnetic resonance angiography demonstrated a double aortic arch forming a vascular ring, thus compressing the esophagus (B to D). This is a rare congenital cardiovascular disorder (1%), usually diagnosed at an early age. It is possible to reach middle to late adulthood with this pathology, as shown by this patient, and it can produce severe symptoms by compressing the trachea and esophagus. AA ϭ ascending aorta; E ϭ esophagus; LCCA ϭ left common carotid artery; LSA ϭ left subclavian artery; PA ϭ pulmonary artery; RCCA ϭ right common carotid artery; RSA ϭ right subclavian artery; T ϭ trachea.

Congenital vascular rings: A clinical challenge for the pediatrician

“…Feeding difficulties such as dysphagia, slow feeding, and hyperextension of head while eating may present later in life since liquid diets are tolerated earlier and symptoms typically manifest when solid foods are initiated . Disphagia may represent an isolated symptom in 5–15% of reported cases, while it may be associated to respiratory symptoms in one‐third of cases at presentation …”

“…VRs can become symptomatic even in adult patients. In fact, Fernandez–Valls et al described the case of a 62‐year‐old woman presenting with dysphagia that led to the diagnosis of a DAA; while Ochi et al described a 56‐year‐old man with epygastric pain and weight loss >10% in a 6‐month period whose CT scan led to a DAA diagnosis with ARSA …”

Noisy Breathing in an Infant: A Case Report

“…Identification of vascular rings may be delayed (even into adulthood) in patients with mild symptoms or sufficiently overlapping symptoms with more common pathologic conditions [1,2,5]. A successful diagnosis requires the clinician to remain open-minded and to continually reassess potential diagnoses, particularly in the setting of an insufficient response to treatment [1].…”

Asymptomatic Double Aortic Arch Accidentally Diagnosed for a Child with T-Cell Lymphoma - Case Report

“…(11,12) The literature reported very few cases diagnosed late or during adolescence or adulthood. (10,(13)(14)(15)(16)(17)(18) Clinically most of the anatomical variants are usually symptomatic especially that are associated with congenital heart defects, including also Fallot tetralogy. (12) Among symptomatic variants, without associated diseases, the most common is the constrictive traheo-esofagian vasculo-ligamentar ring.…”