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Pulmonary function tests leading to the diagnosis of vascular ring in an infant
Israel Amirav1, Moshe Rotschild, Ephraim Bar-Yishay
1Pediatric Department, Sieff Hospital, Safed, Israel. amirav@012.net.il
Insights
An aberrant right subclavian artery caused chronic cough and wheezing in an infant. Conservative management led to symptom improvement, highlighting a less invasive approach for this vascular anomaly.
Area of Science:
- Pediatric Pulmonology
- Cardiovascular Development
- Medical Imaging
Background:
- Infants presenting with persistent respiratory symptoms like chronic cough and wheezing often require thorough investigation.
- Unresponsive asthma symptoms in infants can indicate underlying structural or vascular anomalies.
- Early diagnosis of congenital conditions is crucial for effective management.
Observation:
- A 5-month-old infant exhibited chronic cough and wheeze unresponsive to standard asthma therapies.
- Pulmonary function tests suggested an upper airway obstruction.
- Diagnostic imaging, including barium swallow, bronchoscopy, and CT angiography, revealed an aberrant right subclavian artery.
Findings:
- The aberrant right subclavian artery was identified as the cause of the infant's respiratory symptoms.
- A conservative medical management strategy was adopted due to the mild nature of the symptoms.
- Follow-up at one year demonstrated a significant reduction in both respiratory and gastrointestinal issues.
Implications:
- This case underscores the importance of considering vascular anomalies in the differential diagnosis of pediatric respiratory distress.
- Conservative management can be effective for certain vascular ring anomalies, avoiding surgical intervention.
- Early identification and appropriate management of aberrant subclavian artery can improve infant outcomes and quality of life.
Abstract:
A 5-month-old baby was referred to our pulmonary clinic because of chronic cough and wheeze, unresponsive to antiasthmatic treatment. Examination in the Infant Pulmonary Function Laboratory suggested an upper airway obstruction. An aberrant right subclavian artery was subsequently confirmed by a barium swallow, flexible bronchoscopy, and an angiographic reconstructed chest CT study. Due to modest symptoms a conservative medical approach was taken. At follow-up 1 year later, the patient had fewer respiratory and gastrointestinal symptoms.