Cover Image: Persistent stridor and wheezing in an infant
Abraham Benatar and Frank van Tussenbroek
Paediatric Cardiology, Academic Hospital, Vrije Universiteit Brussel, Brussels, Belgium
An 8-month-old infant was hospitalized for persistent wheezing and stridor of 1 month duration, unresponsive to aerosol inhalations and bronchodilators. Physical examination revealed a well-nourished infant, with all pulses palpable, pulsus paradoxus of 14 mm Hg, evidence of stridor, hyperinflation, and wheezing with prolonged expiration. Barium swallow study demonstrated a high thoracic posterior oesophageal indentation. Echocardiography raised the possibility of a double aortic arch. Bronchoscopy identified compression at the junction of the trachea with the right main bronchus; CT-scan suggested a double aortic arch, with a left descending aorta. This was confirmed with digital subtraction angiography. The left anterior arch was surgically disconnected from the right with immediate relief of symptoms.
Figure legend:
Panel A: Chest X-ray.
Panel B: Echocardiography from supra-clavicular view. Arrows point to origin of two head and neck vessels from one arch, other arrow origin of the second aortic arch.
Panel C: CT scan at high thoracic level showing double aortic arch encircling the trachea.
Panel D: Digital subtraction angiogram (DSA) in AP view.
Panel E: DSA in right anterior oblique view.
Panel F: DSA in left anterior oblique view.
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