Double aortic arch associated with tracheal and esophageal compression in an adult

Abstract

A 44-year-old female admitted to cardiology clinic with complaints of heartburn and chest pain. Past medical history displays hypertension, and she is on medical therapy. Physical examination, laboratory, electrocardiography, echocardiography and spirometer were normal. Chest roentgenogram demonstrated suspicious opacification over aortic arch (Fig. 1A). CT showed; double aortic arch in the form of complete vascular ring around trachea and esophagus. Both the trachea and esophagus were compressed by vascular ring (Video 1, Fig. 1B-E). Esophagogram shows extrinsic impression on left-side of barium-filled esophagus from left-sided arch (Fig. 1F). Therapeutic strategy balanced between risks of cardiovascular abnormality and risks due to surgery. Surgery wasn't performed due to; patient refused operation, vascular ring isn't associated with serious complications and good general condition and prognosis of patient. Hereby conservative approach adopted.Aortic vascular anomalies should be considered in patients with respiratory distress, nutritional problems, and pulmonary infections. Also, identification is important for prevention of chronic and irreversible complications.Mutlu Çağan Sümerkan, Füsun Helvacı, Muzaffer Başak* Departments of Cardiology and *Radiology, Şişli Hamidiye Etfal Education and Research Hospital; İstanbul-Turkey Video 1. 3-dimensional CT video demonstrated double aortic arch. Right arch is higher than left and both arches had similar diameters. Left subclavian and common carotid arteries originated individually from the left aortic arch, moreover right subclavian and common carotid arteries originated individually from right aortic arch

Airway management in vascular central airway obstruction: a literature review

“…Vascular rings [35] -Double aortic arch [44][45][46][47][48][49][50][51][52][53][54] -Right-sided double aortic arch and descending aorta [55] -Double aortic arch with Kommerell's diverticulum [63] -Left aortic arch with right ligamentum arteriosum and right descending aorta [33] with aberrant right subclavian artery [36] with aberrant right subclavian artery and Kommerell's diverticulum [38] -Right aortic arch [64] with aberrant left subclavian artery and left ligamentum arteriosum [36,39,43] with aberrant left subclavian artery and Kommerell's diverticulum [38,[40][41][42][43] -Pulmonary artery sling [56][57][58] Congenital aortic arch anomaly -Kommerell's diverticulum [21,22,[59][60][61] -Cervical aortic arch aneurysm [62] Congenital innominate artery anomaly -Anomalous innominate artery [65] Congenital heart diseases Pulmonary atresia and major aortopulmonary collateral arteries in Tetralogy of Fallot [32] Atrial septal defect [66] CAO, central airway obstruction.…”

“…43], double aortic arch [44][45][46][47][48][49][50][51][52][53][54], right-sided double aortic arch coexistence with a right-sided descending thoracic aorta [55], and pulmonary artery sling [56][57][58]; aneurysms arising from congenital aortic arch anomaly-Kommerell's diverticulum [21,22,[59][60][61] and cervical aortic arch [62]; Kommerell's diverticulum in combination with vascular rings [63]; rightsided aortic arch [64]; and anomalous innominate artery [65] can cause vascular CAO in adults. Also, congenital heart diseases that cause aneurysmal artery dilation, for example, atrial septal defect accompanied with dilated right pulmonary artery [66], and pulmonary atresia with aneurysmally dilated aortopulmonary collateral arteries in Tetralogy of Fallot [32] may obstruct the tracheobronchial tree in adults when the extraluminal pressure arising by the dilated arteries exceeds the durability of the airway.…”