1640 Stridor in An Infant with Double Aortic Arch

Abstract An eleven-month-old infant presented to our casualty with stridor that had been noticed by the parents a few weeks earlier and became increasingly evident lately. They did not recall a specific event when the infant “chocked”, but they denied any recent history of respiratory tract infection. The infant had no relevant medical or surgical history, and he was born full term with normal vaginal delivery. Examination of the infant showed moderate biphasic stridor with both suprasternal and intercostal recessions. Oxygen saturation on room air was 94% and temperature was 37.1°. Chest auscultation revealed bilateral equal air entry, though decreased, with transmitted stridor. No lung crepitations were appreciated. Suspicion of unwitnessed foreign body aspiration arose, and a decision of diagnostic rigid bronchoscopy was taken. Rigid bronchoscopy revealed no foreign body along the tracheobronchial tree, but evident circumferential constriction of the lower trachea was noted with tendency of the tracheal wall to collapse upon withdrawal of the bronchoscope. Following recovery, computed tomography with contrast of the neck and chest was done and a vascular ring, consisting of double aortic arch, was found compressing and narrowing the trachea. Further follow up over the following 6 months showed marked improvement of his distress, and active observation was continued. Conclusions Although foreign body aspiration is the commonest cause of stridor in infants and young children, external compression of the trachea, particularly with vascular rings, should be considered in children with otherwise unexplained stridor.

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Role of virtual bronchoscopy in children with a vegetable foreign body in the tracheobronchial tree

The Journal of Laryngology & Otology ◽

10.1017/s0022215114002837 ◽

2014 ◽

Vol 128 (12) ◽

pp. 1078-1083 ◽

Cited By ~ 15

Author(s):

G Behera ◽

N Tripathy ◽

Y K Maru ◽

R K Mundra ◽

Y Gupta ◽

...

Keyword(s):

Computed Tomography ◽

Foreign Body ◽

Multidetector Computed Tomography ◽

Diagnostic Tool ◽

Foreign Bodies ◽

Three Dimensional ◽

Tracheobronchial Tree ◽

Rigid Bronchoscopy ◽

Foreign Body Aspiration ◽

Virtual Bronchoscopy

AbstractObjectives:Multidetector computed tomography virtual bronchoscopy is a non-invasive diagnostic tool which provides a three-dimensional view of the tracheobronchial airway. This study aimed to evaluate the usefulness of virtual bronchoscopy in cases of vegetable foreign body aspiration in children.Methods:The medical records of patients with a history of foreign body aspiration from August 2006 to August 2010 were reviewed. Data were collected regarding their clinical presentation and chest X-ray, virtual bronchoscopy and rigid bronchoscopy findings. Cases of metallic and other non-vegetable foreign bodies were excluded from the analysis. Patients with multidetector computed tomography virtual bronchoscopy showing features of vegetable foreign body were included in the analysis. For each patient, virtual bronchoscopy findings were reviewed and compared with those of rigid bronchoscopy.Results:A total of 60 patients; all children ranging from 1 month to 8 years of age, were included. The mean age at presentation was 2.01 years. Rigid bronchoscopy confirmed the results of multidetector computed tomography virtual bronchoscopy (i.e. presence of foreign body, site of lodgement, and size and shape) in 59 patients. In the remaining case, a vegetable foreign body identified by virtual bronchoscopy was revealed by rigid bronchoscopy to be a thick mucus plug. Thus, the positive predictive value of virtual bronchoscopy was 98.3 per cent.Conclusion:Multidetector computed tomography virtual bronchoscopy is a sensitive and specific diagnostic tool for identifying radiolucent vegetable foreign bodies in the tracheobronchial tree. It can also provide a useful pre-operative road map for rigid bronchoscopy. Patients suspected of having an airway foreign body or chronic unexplained respiratory symptoms should undergo multidetector computed tomography virtual bronchoscopy to rule out a vegetable foreign body in the tracheobronchial tree and avoid general anaesthesia and invasive rigid bronchoscopy.

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Clinical analysis of tracheobronchial foreign body aspiration in children: a focus on external and intrinsic factors

BMC Surgery ◽

10.1186/s12893-021-01089-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Weigang Gan ◽

Ning Xiao ◽

Yiyuan Feng ◽

Danmei Zhou ◽

Juanjuan Hu ◽

...

Keyword(s):

Foreign Body ◽

Pediatric Patients ◽

Treatment Delay ◽

Rigid Bronchoscopy ◽

Foreign Body Aspiration ◽

External Factors ◽

Factors Affecting ◽

Intrinsic Factors ◽

Common Location ◽

Tracheobronchial Foreign Body

Abstract Background Tracheobronchial foreign body aspiration (TFBA) is a critical disease in children and is extremely dangerous, even life-threatening. The factors affecting the occurrence and prognosis of TFBA are complex. The purpose of this study is to examine the external and intrinsic factors affecting clinical features of TFBA in West China and propose potential effective intervention measures. Methods We retrospectively analyzed the clinical data of pediatric patients diagnosed with TFBA with foreign bodies (FBs) removed by rigid bronchoscopy under general anesthesia at the otolaryngology department from December 2017 to November 2018. The data included age, sex, clinical symptoms, type and location of FB, guardians, prehospital duration and residence of these pediatric patients. Results The ratio of males (72) to females (53) was 1.4:1. Children aged from 1 to 3 years accounted for 76% (95/125) of patients. Cough, continuous fever and dyspnea were the primary symptoms. The right primary bronchus was the most common location of FB detection by rigid bronchoscopy (67 cases, 53.6%). Organic FBs were most common in our study. Guardians of patients significantly differed in the rural (parents 16, grandparents 31) and urban (parents 52, grandparents 26) groups (χ2 = 12.583, p = 0.000). More children in the rural group than in the urban group had a treatment delay longer than 72 h. More children in the group with no history of FB aspiration (12, 25%) than in the group with prior FB aspiration had a treatment delay longer than 72 h. Conclusion Pediatric TFBA is a common emergency in otolaryngology. Age, sex, tracheobronchial anatomy and other physiological elements were defined as intrinsic factors, while guardians, residence, FB species and prehospital time were defined as external factors of TFBA. External and intrinsic factors both influence the occurrence and progression of TFBA. It is extremely important to take effective measures to control external factors, which can decrease morbidity and mortality.

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Double aortic arch: an elusive diagnosis in a child with CHD

Cardiology in the Young ◽

10.1017/s1047951121004856 ◽

2021 ◽

pp. 1-3

Author(s):

Mariana Lemos ◽

Miguel Fogaça da Mata ◽

Ana Coutinho Santos

Keyword(s):

Ventricular Septal Defect ◽

Pulmonary Artery ◽

Aortic Arch ◽

Ct Angiography ◽

Septal Defect ◽

Vascular Ring ◽

Pulmonary Atresia ◽

Double Aortic Arch ◽

Shunt Surgery

Abstract An 18-month-old male with pulmonary atresia and ventricular septal defect presented with stridor after neonatal systemic-to-pulmonary artery shunt surgery, that persisted on follow-up. CT angiography revealed a vascular ring with balanced double aortic arch.

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Complete Vascular Ring Detected by Barium Esophagography

Ear Nose & Throat Journal ◽

10.1177/014556130208100816 ◽

2002 ◽

Vol 81 (8) ◽

pp. 554-555 ◽

Cited By ~ 3

Author(s):

Liam J. Skinner ◽

Stephanie Ryan ◽

John D. Russell

Keyword(s):

Aortic Arch ◽

Vascular Ring ◽

Double Aortic Arch ◽

Vascular Rings ◽

Barium Esophagography

The diagnosis of a vascular ring can be made on the basis of characteristic findings on barium esophagography. We report a case of a double aortic arch in a 9-month-old girl that was diagnosed in this manner, and we briefly review the anatomic characteristics of vascular rings.

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Rigid ventilating video bronchoscope with forceps for bronchoscopic foreign body removal in children

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20192746 ◽

2019 ◽

Vol 5 (4) ◽

pp. 1129

Author(s):

Sagar Jawale ◽

Parthapratim Gupta ◽

Bharti Kulkarni

Keyword(s):

Foreign Body ◽

Gold Standard ◽

Medical Literature ◽

Rigid Bronchoscopy ◽

Foreign Body Aspiration ◽

Indian Children ◽

Foreign Body Removal ◽

Rigid Tube ◽

Pass Through ◽

First Time

Bronchoscopic foreign body removal is a potentially dangerous and challenging procedure in pediatric surgery. bronchoscopy under general anaesthesia is the gold standard of diagnosis and management of foreign body aspiration. A large ventilating channel and better control over the tip of the instrument and cheaper instrument are the merits of rigid bronchoscopy over flexible one. Traditionally a rigid tube alone is used for this purpose which has extreme limitations of vision and it is risky. Foreign body aspiration typically occurs in 6 to 18 month age and the size of glottis is very small at this age. In Indian children who are small and malnourished the large assembly of sheath and telescope mounted forceps does not pass through the glottis. To overcome the limitations of the traditional equipment I designed my own bronchoscopy equipment by my 15 year of experience in bronchoscopy. This type of device is reported for the first time in medical literature and patent is filed for it at Mumbai office.

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P725 An unexpected direction: a case report of a double aortic arch in an asymptomatic woman in adulthood

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.397 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

I Campos ◽

C Vieira ◽

N Salome ◽

V H Pereira ◽

A Costeira Pereira ◽

...

Keyword(s):

Case Report ◽

Aortic Arch ◽

Ct Angiography ◽

Vascular Ring ◽

Double Aortic Arch ◽

Posterior Arch ◽

Vascular Rings ◽

Thoracic Ct ◽

Extrinsic Compression ◽

The Right

Abstract Introduction Complete vascular rings represent about 0.5-2% of all congenital cardiovascular malformations, with the double aortic arch (DAA) being the most common of the complete vascular rings, causing tracheoesophageal compression. The right (posterior) arch is usually dominant (70%), although the two arches can have the same size (5%). The left (anterior) arch is dominant in only approximately 25% of cases. In most cases, this anomaly is diagnosed during childhood due to symptoms caused by oesophageal or tracheal compression. For this reason, case reports of adults are rare. This report describes a case of a 61-year-old woman with DAA with dominant left arch, diagnosed accidentallyby thoracic CT angiography. Case Report Description A 61 years old woman with a previous story of hypertension and type 1 diabetes presented to the emergency service with dyspnoea and thoracic pain. She also referred a history of intermittent dysphagia and cough with at least 12 years of progression. All the parameters of the physical examination were within normal limits. The electrocardiogram showed a normal sinus rhythm with no evidence of acute ischemia and her blood analyses did not show any abnormalitie. She also performed a thoracic CT angiography, which excluded signs of pulmonary embolism, but revealed a vascular ring suggesting a double aortic arch with permeability in both right and left arches as well as their collaterals. The Cardiac MRI was performed with the purpose of excluding ischemia, confirming the double aortic arch with left dominance. The right arch, posterior to the oesophagus and trachea, and the left arch, in an anterior position, showed an anatomic compression of the oesophagus as well as the proximal trachea, capable of eliciting the symptoms mentioned. Other congenital anomalies were excluded. The echocardiography did not demonstrate any additional cardiac malformation. Endoscopy shows a pulsatile extrinsic compression of the esophagus (aortic ring). The patient is currently being studied and closely monitored in the Cardiology consultation. Discussion The most common type of complete vascular ring is the double aortic arch, which accounts for 70% of the complete rings. In most cases, there are two permeable arches, usually with right dominance (70% of the cases). Rarely, both arches are symmetrical. Symptoms usually appear in the fifth month of life. In most cases, only supportive treatment is required. Conclusion This case illustrates the atypical features of this congenital malformation, namely the diagnosis during adulthood as well as the left dominance. Abstract P725 Figure. A double aortic arch

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Anomalous origin of a pulmonary artery in a teenager with tetralogy of Fallot with associated double aortic arch and coronary arteriovenous fistula

Cardiology in the Young ◽

10.1017/s1047951119000933 ◽

2019 ◽

Vol 29 (5) ◽

pp. 727-729

Author(s):

Vishal Agrawal ◽

Parth Solanki ◽

Ritesh Shah ◽

Divyakant Parmar ◽

Amit Mishra

Keyword(s):

Pulmonary Artery ◽

Aortic Arch ◽

Tetralogy Of Fallot ◽

Vascular Ring ◽

Right Ventricular Outflow Tract ◽

Left Pulmonary Artery ◽

Ventricular Outflow Tract ◽

Double Aortic Arch ◽

Anomalous Origin ◽

Tract Fistula

AbstractWe report the case of a 14-year-old female who had tetralogy of Fallot along with anomalous origin of the left pulmonary artery from the ascending aorta with co-dominant double aortic arch forming a complete vascular ring compressing the oesophagus along with a left main coronary artery to right ventricular outflow tract fistula. She underwent surgical correction without conduit placement.

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A gyermekkori alsó légúti idegentest-aspiráció diagnosztikája a klinikai gyakorlatban

Orvosi Hetilap ◽

10.1556/650.2018.31165 ◽

2018 ◽

Vol 159 (51) ◽

pp. 2162-2166

Author(s):

Dániel Hajnal ◽

Tamás Kovács

Keyword(s):

Foreign Body ◽

Standard Procedure ◽

False Negative ◽

Radiological Finding ◽

Paediatric Population ◽

Rigid Bronchoscopy ◽

Foreign Body Aspiration ◽

X Ray ◽

Co Morbidity ◽

Chest X Ray

Abstract: Introduction and aim: Rigid bronchoscopic foreign body removal is the gold standard procedure for foreign body aspiration. We have analysed our results of bronchoscopies and the accuracy of diagnosis among the paediatric population in Southeast Hungary. Method: A retrospective study of children admitted because of suspected solid foreign body aspiration between 2006 and 2017 was performed. Results: From among 220 admitted patients, 86 were suspected of solid particle aspiration. Presenting history was certain in 68.6% (n = 59/86). Sudden choking-like symptoms were present in 61/86 patients (70.9%), coughing in 81/86 patients (94.2%). Thoracic auscultation was positive in 67/86 cases (77.9%), chest X-ray in 75/86 patients (87.2%), while fluoroscopy only in 12/75 cases (16%). 92 bronchoscopies in 86 patients were performed. In 57 bronchoscopies, solid foreign body was found (66.2%) and the removal was successful in 56 cases. Thoracic auscultation was negative in patients with foreign body only in 6/57 cases (10.5%). In the same group, chest X-ray was negative in 33/57 cases (57.9%) and fluoroscopy was positive only in 12/57 patients (21.1%). Pneumonia or prolonged bronchitis was present in 4/86 patients (4.6%). Severe bronchial bleeding occurred in 2/86 cases (2.3%). Mortality was 1.2%, a child with severe co-morbidity and chronic aspiration passed away. Bronchoscopy was negative in 29/86 patients (33.7%). Complications were significantly higher in chronic cases than in the acute ones. Conclusion: Rigid bronchoscopy is indicated if solid foreign body aspiration is suspected and positive anamnesis, typical symptoms (coughing, choking) or positive chest auscultations are present. Diagnosis predominantly based on radiological finding is controversial due to the high possibility of false negative results. Early intervention within the first 24 hours is recommended to avoid complications. Orv Hetil. 2018; 159(51): 2162–2166.

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Double aortic arch presenting as neonatal respiratory failure in the delivery room

Cardiology in the Young ◽

10.1017/s1047951117002335 ◽

2017 ◽

Vol 28 (3) ◽

pp. 476-478

Author(s):

Marc Lee ◽

T. K. Susheel Kumar ◽

Govinda Paudel

Keyword(s):

Respiratory Failure ◽

Airway Obstruction ◽

Aortic Arch ◽

Respiratory Symptoms ◽

Neonatal Period ◽

Vascular Ring ◽

Common Type ◽

Double Aortic Arch ◽

Delivery Room

AbstractRespiratory symptoms are prevalent in vascular ring anomalies, including double aortic arch, which is considered the most common type of vascular ring. However, respiratory failure owing to critical airway obstruction in the neonatal period is rare with few reported cases in the literature. We report a case of a newborn patient who required emergent intubation within the first few hours of life and was later discovered to have a double aortic arch.

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Traheobronchial foreign bodies: evaluation and retrieval by rigid bronchoscopy

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20194925 ◽

2019 ◽

Vol 5 (6) ◽

pp. 1552

Author(s):

Kunzes Dolma ◽

Anchal Gupta ◽

Apurab Gupta ◽

Padam Singh Jamwal

Keyword(s):

Foreign Body ◽

Clinical Examination ◽

Foreign Bodies ◽

Standard Procedure ◽

Neck Surgery ◽

Rigid Bronchoscopy ◽

Foreign Body Aspiration ◽

Female Ratio ◽

Mortality And Morbidity ◽

Delay In Diagnosis

Background: The foreign body aspiration is one of the commonest ENT emergencies. Delay in diagnosis and treatment may lead to significant morbidity and mortality.Methods: The current study was conducted at Department of Otorhinolaryngology and Head and Neck Surgery, SMGS Hospital, Government Medical College, Jammu, from November 2017 to October 2018. All symptomatic patients diagnosed with foreign body aspiration on the basis of history, clinical examination and radiological evaluation and who underwent rigid bronchoscopic retrieval were included in the study. Fifty patients were studied. Results: The majority of patients 33 (66%) were between 1 and 3 years of age.12 (24%) patients were over 3 years of age with oldest of 57 years old age with male: female ratio of 2.1:1. The clinical features of these patients were mainly cough, respiratory distress, wheeze, fever, stridor, choking and cyanosis. On bronchoscopy, foreign body was identified in 46 (92%) patients and no foreign body was seen in 4 (8%) patients with suspected foreign body aspiration. The most common type of foreign body was organic (73.91%), with peanuts (47.82%) being the commonest. The most common site was left bronchus seen in 22 (47.83%) patients followed by right bronchus seen in 18 (39.13%) and trachea seen in 6 (13.04%) patients. Overall mortality and morbidity rates were 2.17% and 4.35% respectively.Conclusions: History and clinical examination should be more relied upon as diagnostic tool than radiological findings in diagnosing foreign body inhalation. Rigid bronchoscopic removal of foreign body is the standard procedure for removing tracheobronchial foreign bodies.

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