Paediatric laryngeal disorders
Declan Costello, Guri Sandhu in Practical Laryngology, 2015
A double aortic arch results in a vascular ring that encircles both the trachea and oesophagus. The most common type is an ascending aorta that splits around the trachea and oesophagus and then re-joins the descending aorta. Other variants include a right aortic arch and a left ligamentum arteriosum. Symptoms commence at birth with predominantly airway problems, and stridor in these cases is usually exacerbated by feeding. Dysphagia is rare due to the predominantly liquid diet in this age group. A contrast swallow can clearly demonstrate the posterior indentation of the oesophagus. CT delineates the full anatomy.
The cardiovascular system
C. Simon Herrington in Muir's Textbook of Pathology, 2020
Anomalies of the aortic arch are commonly associated with Fallot's tetralogy; however, as isolated anomalies they rarely cause symptoms. When a vascular ring is formed around the trachea and oesophagus by a right aortic arch and the left descending aorta, together with a persistent ductus arteriosus, ligamentum arteriosum, or anomalous left subclavian artery, pressure effects may result, mainly on the trachea. A double aortic arch may give similar symptoms.
Test Paper 2
Teck Yew Chin, Susan Cheng Shelmerdine, Akash Ganguly, Chinedum Anosike in Get Through, 2017
Anterior tracheal, posterior tracheal and lateral oesophageal impression occurs with double aortic arch. The right arch is higher than the left, resulting in an S-shaped oesophagogram on AP view. Reverse ‘3’ indentation of the oesophagus and normal trachea occurs with coarctation of the aorta.
Aberrant right subclavian artery: the association with chromosomal defects and the related post-natal outcomes in a third level referral centre
Published in Journal of Obstetrics and Gynaecology, 2022
Maddalena Morlando, Carmela Morelli, Fortuna Del Gaizo, Adelaide Fusco, Federica De Fazio, Laura Di Pietto, Gianfranco Moccia, Ludovica Spinelli Barrile, Antonio Schiattarella, Pasquale De Franciscis, Nicola Colacurci, Maria Giovanna Russo
Fifty fetuses were diagnosed antenatally with ARSA between January 2013 and September 2019 at our unit. In all cases the diagnosis of ARSA was confirmed after birth. Mean gestational age at diagnosis was 25.8 ± 3.8 weeks. The indications for referral are reported in Table 1. The presence of ARSA was an isolated finding in 46 fetuses (92%), while in 4 fetuses the ARSA was associated with other cardiac and/or extra-cardiac anomalies. In one fetus ARSA was associated with double aortic arch; in one fetus with a muscular ventricular septal defect (VSD); in one fetus with the persistence of left superior vena cava. Only one fetus presented an extracardiac abnormality, namely unilateral renal agenesis. Karyotype was unknown in 35 cases, and none of these fetuses presented a diagnosis of trisomy 21 at birth. Among women who opted for invasive testing, karyotype was found to be normal in 14 cases. Only one fetus was diagnosed with trisomy 21 (2%) and this was also the indication for fetal echocardiography. In this fetus the ARSA was the only ultrasound anomaly identified. All women had an uncomplicated delivery at term. In all cases the diagnosis of ARSA was confirmed after birth. In two cases the presence of ARSA was associated with a VSD which had not been identified at prenatal scanning. There were no cases necessitating referral due to the presence of compression symptoms at birth in our series.
Comparative study between multi-detector computed tomography and echocardiography in evaluation of congenital vascular rings
Published in Alexandria Journal of Medicine, 2018
Manal Hamisa, Fatma Elsharawy, Wafaa Elsherbeny, Suzan Bayoumy
All patients underwent echocardiography using (vivid 7, GE, Hortin Norway using probe 5S MHZ), patients under 4 years were sedated using chloral hydrate (1 mg/kg), patients were examined in reclining position and complete study for cardiac structure were done. The transducer is positioned at first at suprasternal notch, starting show downward angulation then sweep upward to allow identification of aortic arch position and its relation to trachea and branching of great vessels of head and neck. In left aortic arch, the first branch heads to the right and then bifurcates into right subclavian and right common carotid arteries. While in (right aortic arch with mirror-image branching) the first branch was seen to head to the left and then bifurcates into left subclavian and left common carotid arteries. An (aberrant subclavian artery) should be suspected if the first branch does not bifurcate. In (double aortic arch) if both archs are patent so we can detected them in transverse suprasternal view. From parasternal short axis- views at level of bifurcation of pulmonary artery and at supra sternal view, echocardiography can reveal continuation of pulmonary trunk to right and when we cannot see the origin of left pulmonary artery we must suggest either absence or aberrant origin of left pulmonary artery. Pulmonary sling is seen when the origin of left pulmonary artery arises from the right pulmonary artery, it is suggested when pulmonary trunk is followed to the right side. However information taken by echocardiography examination is inadequate, and also evaluation of the anatomy of the airways is difficult by ultrasound.
Pediatric bronchoscopy: recent advances and clinical challenges
Published in Expert Review of Respiratory Medicine, 2021
P Goussard, P Pohunek, E Eber, F Midulla, G Di Mattia, M Merven, JT Janson
The role of bronchoscopy in preschool wheezing includes evaluating the airways for any structural and anatomical abnormalities. It is also important to always evaluate the upper airways with flexible nasoendoscopy and laryngoscopy and not just a flexible bronchoscope through a laryngeal mask airway. Large airways can be either structurally or functionally abnormal or can present with a combination of abnormalities. Tracheomalacia and bronchomalacia can be missed if the child is not breathing spontaneously. Vascular abnormalities are more commonly found than airway stenosis. These abnormalities can include double aortic arch, innominate artery compression, left pulmonary artery sling, or left main bronchus (LMB) compression by a patent ductus arteriosus remnant [39]. The pattern of compression seen on bronchoscopy can be a guide to the type of vascular compression present.
Related Knowledge Centers
- Aortic Arch
- Atresia
- Chest Radiograph
- Descending Aorta
- Hypoplasia
- Trachea
- Vascular Tissue
- Esophagus
- Aortic Arches
- Vascular Ring