Presentation
Dyspnea, low oxygen saturation.
Patient Data
Double aortic arch with patent lumen, completely encircling the trachea and esophagus (complete vascular ring). The right arch is slightly higher and larger than the left one measuring 8 mm and 6 mm respectively. No evidence of atretic segment.
The right arch gives off the right common carotid and right subclavian arteries while the left arch gives off the left common carotid and left subclavian arteries. This is associated with severe segmental luminal narrowing of the supra-carinal trachea; about 12 mm in length with residual luminal diameter about 1.2 mm mounting to 80% diameter stenosis. The rest of tracheobronchial tree is unremarkable.
Double aortic arch, encircling the trachea and esophagus with 80% luminal narrowing of supra-carinal trachea.
Case Discussion
First, the pediatrician performed bronchoscopy that revealed thoracic tracheal narrowing by more than 80% and the possibility of a vascular ring was primarily considered that revealed clearly on contrast enhanced CT. Double aortic arch is the most common symptomatic type of aortic arch variant and vascular rings. Both the trachea and esophagus are encircled. Respiratory symptoms are common in infancy. Right arch dominance is the most common accounting for 80% of cases as in this case.
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