Aortic Wheeze: Intermittent Tracheal Obstruction Caused by a Rare Aortic Arch Anomaly

Abstract

Cardiac and aortic arch anomalies are a well-known cause of tracheal and esophageal compression producing stridor and dysphagia. We present a rarely encountered aortic arch anomaly in a 12-month-old infant who suffered from intermittent pulmonary wheezing. A discussion of the subsequent evaluation including an esophageal contrast study, computed tomography, angiocardiography, and bronchoscopy, will emphasize the diagnostic importance of these examinations. Preoperatively, a variant of Celoria type B aortic arch interruption was established by cardiac catheterization. The ascending aorta solely supplied both carotid arteries. Both subclavian arteries arose from the descending aorta, and all flow to the descending aorta was supplied via bilateral markedly enlarged vertebral arteries as a bilateral subclavian steal. Three areas of tracheal compression were noted at bronchoscopy. The patient's anomalous circulation was improved by the placement of a Gore-Tex graft connecting the ascending and descending aorta. A right-sided arterial ligament was divided in order to further relieve tracheal compression.

A preoperative consultation for a patient with chronic cough and wheeze

“…It is likely that the narrow airway is further compromised by oedema and secretions, as well as the increased respiratory demand associated with the infection. Similar clinical pictures have been described in children [4,6], but not, to my knowledge, in adults at this older age.…”

Tracheoesophageal compression due to congenital vascular anomalies (vascular rings)

“…Physical exertion may exacerbate symptoms. 48,49 Recurrent lower respiratory tract infections are common as it is difficult for these children to clear secretions distal to the tracheal stricture. Pulmonary infections may be the presenting symptom of a VR, especially in older children.…”

Pre- and post-operative MRI study of an aneurysm of the right brachiocephalic artery with tracheal compression

“…The rare symptomatic forms may be life-threatening due to lower airway compression necessitating early diagnosis and surgical management. Their diagnosis rests on the association of barium oeosophagography, tracheobronchoscopy, angiography, and more recently on cardiac MRI [1,2]. We report on an infant with aortic stenosis who suffered from severe tracheal compression due to aneurysmal transformation of the brachiocephalic trunk.…”