Recurrent respiratory infections caused by a double aortic arch: The diagnostic role of spirometry

Abstract

A young woman with a clinical history characterized by recurrent respiratory infections, occurring since early infancy, was referred to our hospital. When the patient was a young girl, she underwent sweat chloride test, serum analysis of immunoglobulins, and evaluation of blood lymphocyte subsets; all these diagnostic tests were normal, as well as chest X ray aside from pneumonia episodes. Skin prick tests were positive for several different allergens, and a diagnosis of allergic rhinitis was made. At the age of 11 years, she started to complain of gastroesophageal reflux disease (GERD) symptoms, and a gastroscopy detected a hiatal hernia with esophagitis. Despite pharmacologic treatments for allergic rhinitis and GERD, the patient continued to complain of chronic cough, associated with choking and recurrent respiratory infections treated with antibiotic therapy. For the first time in her life, we performed a spirometry that showed a flow-volume curve characterized by a plateau in the expiratory phase, suggestive of an central airway obstruction. Bronchoscopy demonstrated a compression of the distal portion of trachea. Computed tomography (CT) angiogram revealed a double aortic arch. Barium enhancement evidenced an esophageal compression. A surgical division of the smaller of the two arches was then performed. Therefore, we strongly suggest to perform lung function tests in all cases of unexplained respiratory complaints.

Double Aortic Arch Mimics the Clinical Characteristics of Severe Reactive Airway Disease in a Pediatric Patient

“…The optimal treatment of options for these types of cases is usually the surgical division of the nondominant branch of DAA from the dominant branch of DAA. 7,8 Our patient was operated on the seventh day of her hospitalization. The compression of the trachea and esophagus due to the DAA was observed during the surgery, and the posterior aortic arch was divided to release the obstruction.…”

Recurrent Wheezing and Cough Caused by Double Aortic Arch, Not Asthma

“…DAA may be of right dominant (70% case), left dominant (25% case), and balanced type (5%). The ring of the DAA causes the compression of the airway and induced recurrent wheezing [16]. These rare congenital vascular disorders cause a complete or partial encirclement of trachea and esophagus.…”

Sarcoidosis-Associated Pulmonary Hypertension Treated with Sildenafil

“…Diagnostic difficulties arise with patient age. Symptoms caused by vascular compression of the trachea and/or the esophagus can very easily mimic more common diseases like: asthma, gastro-esophageal reflux disease [5,6] or even unspecified eating disorder [7].…”