Imaging description

A 16-month-old girl presented to the emergency room with fever and shortness of breath and was wheezing with mild hypoxemia on examination. Her mother offered a history of noisy breathing since birth and repeated episodes of wheezing and respiratory infection. The chest radiographs were interpreted as normal in the emergency room; the infant was admitted to the hospital for probable viral upper respiratory infection. The radiologist called the next morning to report that the chest radiographs demonstrated abnormality of the intrathoracic airway including a right-sided impression on the trachea, possibly representing a right aortic arch (Fig. 25.1a) as well as narrowing and anterior bowing (Fig. 25.1b) of the lower trachea. The appearance raised the question of a vascular ring with tracheal compression.

A CT angiogram was obtained which demonstrated a vascular ring consisting of a double aortic arch variant with atresia of the distal left arch adjacent to a Kommerel diverticulum (Fig. 25.1c–e). The right arch was larger than the left with the descending aorta in the midline. The vascular ring encircled the trachea and esophagus with marked compression of the lower trachea at the site of the vascular abnormality.