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Asthma-like symptoms: is it always a pulmonary issue?
Davide Piloni1,2, Claudio Tirelli3, Rita Di Domenica1
11Department of Medical Sciences and Infective Diseases, Unit of Respiratory Diseases, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.
Insights
Double aortic arch, a rare congenital vascular ring, can present in adulthood with persistent cough. Suspecting this anomaly is crucial for diagnosing difficult-to-treat asthma.
Area of Science:
- Cardiology
- Thoracic Surgery
- Pediatric Surgery
Background:
- Double aortic arch is a rare congenital vascular anomaly forming a complete ring around the trachea and esophagus.
- Typically diagnosed in infancy, symptoms often involve respiratory and gastroesophageal issues.
Observation:
- A 20-year-old female presented with persistent dry cough, a history of childhood recurrent bronchitis, anorexia, and allergic asthma.
- Pulmonary function tests initially suggested an intrathoracic obstruction, which persisted despite asthma treatment.
Findings:
- Diagnostic imaging, including chest CT, echocardiography, fiberbronchoscopy, and esophageal radiography, confirmed a double aortic arch.
- The patient's persistent respiratory symptoms were attributed to this congenital vascular anomaly.
Implications:
- This case highlights that double aortic arch can manifest in adulthood with atypical respiratory symptoms.
- Congenital vascular anomalies should be considered in cases of refractory asthma or persistent cough, especially when flow/volume curves indicate obstruction.
Background:
Double aortic arch is a rare congenital and complete vascular ring around trachea and esophagus. It is usually diagnosed during infancy. The symptoms are generally related to respiratory and gastroesophageal tracts.
Case Presentation:
A 20-year-old female patient was referred to our outpatient clinic for persistent dry cough. She had a history of an episode of inhalation of food bolus as an infant and recurrent bronchitis, anorexia and allergic bronchial asthma since the childhood. Since the beginning, an intrathoracic obstruction was suspected at pulmonary function tests. After 1 month of complete asthma treatment, the cough was unchanged and the spirometry confirmed the presence of an intrathoracic obstruction. Then, she underwent a chest CT with contrast medium, a contrast transthoracic echocardiography, a fiberbronchoscopy and an esophageal radiography with contrast medium. The final diagnosis was made and a double aortic arch was found.
Conclusion:
A careful observation of the flow/volume curve should always be guaranteed and the presence of congenital vascular anomalies should be suspected in case of difficult-to-treat asthma.
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