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A Case of Vascular Rings Presenting as Chronic Cough

Oleg Epelbaum

Rohit Kapoor


Premila Paul


Soumya Sachdeva

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Conference: 2014 International PHA Conference and Scientific Sessions

Release Date: 06.22.2014

Presentation Type: Abstracts

File Download: 2014 Conference Abstract - Rohit Kapoor

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Chronic cough; as a congenital vascular anomaly ,may be encountered in clinical practice. We diagnosed a case of complete vascular ring, compressing the trachea and bronchus; the ring being constituted by right aortic arch with aberrant origin of left subclavian artery with left ligamentum arteriosum.

Background: Chronic cough; as a congenital vascular anomaly ,may be encountered in clinical practice. We diagnosed a case of complete vascular ring, compressing the trachea and bronchus; the ring being constituted by right aortic arch with aberrant origin of left subclavian artery with left ligamentum arteriosum.

Results: A 15 year old male child started to have noisy breathing and difficulty in swallowing; which was gradually progressive in severity since the age of 1 year. History of multiple chest infections treated as bronchopneumonia byover the counter antibiotics, bronchodilators and physiotherapy was reported. The child was never asymptomatic and suffered from cough. Physical examination revealed a febrile,tachypnoeic and tachycardiac child. Respiratory examination revealed intercostal and subcostal retractions; more prominent on the right side and auscultation revealed crepitation on both lung fields; more pronounced on the right side. Rest of the systemic examination was unremarkable. Hematological workup revealed leukocytosis and a positive CRP. Spirometry demonstrated a mixed obstructive and restrictive pattern due to normal emptying of the unaffected side and slow emptying of the affected side. Chest x ray revealed upper mediastinal homogenous opacity on the right side on serial x rays. Barium swallow revealed a deep persistent impression on posterior aspect of oesophagus. Contrast CT angiography showed a right aortic arch and origin of LSCA from distal aortic arch crossing towards the left side. The ECHO findings were consistent with the presence of a right aortic arch, with no structural anomalies of the heart. On Bronchoscopy; a distinct bulge in right anterior aspect of trachea just above the carina was noticed. Further, right bronchus was edematous and pulsations were noted. All cultures including BAL were negative. For the definitive management, The pressing bronchus was divided and tracheal cartilage reinforced. Operative findings included the presence of a right sided aortic arch with left descending aorta,aberrant origin of left subclavian from distal arch of aorta and LDA; present in the form of a fibrous cord pressing the left bronchus. The patient’s  stridor significantly improved after the surgical procedure was performed.

Conclusions: Thus in a case with aerodigestive symptoms with recurrent pneumonias; the possibility of congenital vascular rings must be considered. 

Type: Case Study