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Correlapaedia - a Correlative Encyclopedia of Pediatric Imaging, Surgery, and Pathology
The patient was a 1 month old female with biphasic stridor since birth that increases in intensity when the child is agitated or feeding.
Clinical Physical Exam:
Biphasic stridor, most pronounced over the upper trachea.
Clinical Differential Diagnosis:
Vascular ring due to a double aortic arch or a left aortic arch with an aberrant right subclavian artery
An upper GI exam demonstrated a left sided aortic arch with a posterior indentation on the esophagus. An echocardiogram performed later demonstrated a double aortic arch with both limbs being of fairly equal caliber.
Images 1 and 2
Imaging Differential Diagnosis:
Left aortic arch with aberrant right subclavian artery, double aortic arch.
Esophagoscopy and laryngoscopy was performed one day after the Upper GI and demonstrated compression of the anterior wall of the trachea by a pulsating vessel, felt to be innominate artery. Compression of the posterior wall of the mid-esophagus was also seen and felt to be caused by a pulsating blood vessel. The vascular ring was electively divided 6 days later via a left posterolateral thoracotomy. The posterior aortic arch was divided, causing an impressive release of the ring with the 2 ends of the posterior arch separating by 2 to 3 centimeters. The ligamentum arteriosum was then divided.
Double Aortic Arch, Complete Vascular Ring
Follow-up and Prognosis:
The patient had an uncomplicated post-operative course.
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