Complete Vascular Ring due to Double Aortic Arch causing Esophageal Compression: A Rare Case of Recurrent Aspirations in a Toddler
Dikshitha Kotian, B. S. Prasad, Prem Alva, Jayashankar Marla, Santosh Soans, Bharath ShettyAbstract
Background:
Vascular ring with double aortic arch is a rare congenital anomaly, which encircles the esophagus and trachea, causing compressive symptoms.
Clinical Description:
A 13-month-old boy presented with a history of recurrent episodes of choking and respiratory distress requiring multiple hospitalizations over the past 1 year. Examination revealed mild pallor, moderate malnutrition, and respiratory distress with stridor.
Management and Outcome:
Investigations revealed low hemoglobin, raised total leukocyte count, and right-sided consolidation in chest X-ray. Echocardiography, contrast swallow, and noncontrast computed tomography (CT) of the chest were normal in the case CECT is mentioned or specify if CECT chest was performed with angiography protocols. CT angiography revealed a right-sided aortic arch with a complete vascular loop indenting on the esophagus. Surgical division of the nondominant arch, ligamentum arteriosum, and Kommerell’s diverticulum was performed. The follow-up was uneventful with the resolution of symptoms and improved growth.
Conclusion:
Vascular ring compression should be considered in infants with recurrent aspirations and failure to thrive. Comprehensive evaluation including CT angiography can provide an accurate diagnosis. Surgical intervention may be undertaken in case of persistent symptoms.