Oesophageal foreign body and a double aortic arch: rare dual pathology

Abstract

To our knowledge, this is only the second reported case of a double aortic arch being diagnosed in a patient following removal of an oesophageal foreign body.

Bronchoscopy versus multi-detector computed tomography in the diagnosis of congenital vascular ring

“…In three of our 10 cases, bronchoscopy detected associated anomalies: laryngomalacia in a case of double aortic arch; a glottic web in a patient with a double aortic arch; and tracheomalacia in a case of anomalous innominate artery. O'Connor and Cooney 6 have stated that, in cases of congenital vascular ring, bronchoscopy is also useful to document normal vocal fold movement prior to cardiothoracic surgery, and to detect coexisting airway pathology.…”

“…Patients with airway symptoms usually present earlier, while those with oesophageal symptoms present later in childhood, often when solid food is introduced. 6 Computed tomography technology has improved dramatically, and now constitutes the backbone of aortic disease imaging and evaluation. double aortic arch) or anatomically incomplete (e.g.…”

“…In a child with a vascular ring, bronchoscopic examination may demonstrate extrinsic (often pulsatile) compression of the trachea 5 . Bronchoscopy is also useful to check vocal fold mobility prior to any planned cardiothoracic surgery, and to exclude any associated airway anomaly 6 …”

Congenital vascular rings: A clinical challenge for the pediatrician

“…All symptomatic patients requiring surgical treatment should undergo bronchoscopy to define the level and extent of tracheal narrowing and evaluate for complete tracheal rings or other unexpected pathology . Bronchoscopy can be repetead to evaluate the outcome of surgery by comparing preoperative and postoperative images, to follow up the airway malacia evolution; and it can also be used to rule out other causes of respiratory distress such as aspiration of a foreign body or subglottic stenosis . In all cases an extreme degree of caution is necessary during and after bronchoscopy as the tracheal lumen, already narrowed by the vascular compression, may be compromised further by edema from bronchoscopic manipulation …”

“…Although it can detect aortic arch anomalies such as VRs, it does not represent a dominant diagnostic tool, because it is limited by acoustic windows, a lack of depiction of airway/esophageal involvement and high interobserver variability . The addition of Doppler color flow imaging is helpful in assessing for a ductus arteriosus and arch patency . VR segments without lumens cannot be displayed …”