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Double aortic arch presenting as severe bronchiolitis in a 2-week-old infant
Amanda L Griffiths1, John Massie, Mike South
1Department of Respiratory Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia. mandie.griffiths@rch.org.au
Journal of Paediatrics and Child Health
|June 15, 2005
Summary
A difficult-to-ventilate infant with stridor and respiratory distress was diagnosed with extrinsic tracheal compression caused by a double aortic arch. Correcting endotracheal tube position resolved the obstruction, highlighting key diagnostic clues.
Area of Science:
- Pediatric Pulmonology
- Cardiovascular Surgery
- Neonatal Intensive Care
Background:
- Severe respiratory distress in neonates presents diagnostic challenges.
- Difficult mechanical ventilation in infants requires thorough investigation.
- Congenital airway anomalies can mimic common respiratory illnesses.
Observation:
- A 2-week-old infant with stridor and severe respiratory distress required mechanical ventilation.
- Ventilator waveforms indicated significant inspiratory and expiratory flow obstruction.
- Bronchoscopy revealed extrinsic mid-tracheal compression, resolved by endotracheal tube repositioning.
Findings:
- A double aortic arch was identified as the cause of extrinsic tracheal compression.
- The infant's cardiac anatomy was otherwise normal.
- Successful management involved adjusting endotracheal tube placement.
Implications:
- This case underscores the importance of integrating clinical history, physical examination, and ventilator waveform analysis.
- Early identification of extrinsic airway compression is crucial for managing difficult-to-ventilate infants.
- Double aortic arch should be considered in the differential diagnosis of neonatal respiratory distress and airway obstruction.