Correlapaedia - a Correlative Encyclopedia of Pediatric Imaging, Surgery, and Pathology

Case 2

Clinical History:
The patient was a 2 year old male who had stridor since birth. As a 1 year old he was incidentally found to have a vascular ring on an upper GI exam performed during a workup for vomiting. An echocardiogram further categorized the vascular ring as a right aortic arch with an aberrant left subclavian artery. The patient now presented with increasingly noisy breathing during exertion and frequent upper respiratory infections.

Clinical Physical Exam:
Unremarkable

Clinical Labs:
Non-contributory

Clinical Differential Diagnosis:
Right aortic arch with aberrant left subclavian artery, double aortic arch

Imaging Findings:
The preoperative upper GI (not available) was performed at an outside institution and demonstrated a posterior indentation on the esophagus. Post-op AP chest x-ray from 4/15/94 demonstrated a right sided aortic arch.

Image 1

Imaging Differential Diagnosis:
Right aortic arch with aberrant left subclavian artery, double aortic arch

Operative Findings:
Rigid bronchoscopy and endoscopy showed anterior bulging of the posterior wall of esophagus and a posterior bulging of the anterior wall of the trachea. There was dramatic narrowing of the trachea and esophagus. The patient was taken electively to the operating room and explored via a left posterolateral thoracotomy. The patient had the vascular ring divided by division of the ligamentum arteriosum. The ring sprang open dramatically, providing ample room for the esophagus.

Image 2

Image 3

Pathological Findings:
None

Final Diagnosis:
Right Aortic Arch, Left Ligamentum Arteriosum, Aberrant Left Subclavian Artery, Incomplete Vascular Ring

Follow-up and Prognosis:
The patient had an uncomplicated post-operative course.

Similar Cases:
Case 13

References:

• Paediapedia

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