Congenital vascular abnormality presenting as life-long asthma

Area of Science:

• Cardiology
• Pulmonology
• Radiology

Background:

• Adult-onset asthma can present with atypical symptoms.
• Persistent respiratory symptoms despite optimal medical management warrant further investigation.
• Upper airway obstruction can mimic lower airway diseases like asthma.

Purpose of the Study:

• To report a case of adult-onset asthma misdiagnosis.
• To illustrate the diagnostic utility of spirometry and imaging in identifying vascular anomalies.
• To emphasize the importance of considering alternative diagnoses in refractory asthma.

Main Methods:

• Clinical assessment including spirometry with Empey index and flow-volume loops.
• Computed tomography (CT) imaging with aortic angiography.
• Surgical intervention for vascular ring anomaly.

Main Results:

• Spirometry revealed an obstructive pattern and elevated Empey index, suggesting upper airway obstruction.
• CT imaging identified a right-sided aortic arch with Kommerrell diverticulum causing tracheoesophageal compression.
• Post-surgical intervention showed significant improvement in dyspnea, cough, and pulmonary function tests (FEV1, PEF).

Conclusions:

• Vascular rings can present insidiously in adulthood, mimicking asthma.
• The Empey index and flow-volume loops are valuable tools for diagnosing upper airway obstruction.
• Surgical correction of vascular anomalies provides effective treatment for associated respiratory symptoms.