Ductus arteriosus aneurysm in a neonate with inspiratory stridor

Inspiratory stridor in neonates is typically attributable to laryngomalacia, vocal cord paralysis, or subglottic stenosis. Less commonly, vascular anomalies can cause inspiratory stridor.

A neonate developed progressive, position-dependent inspiratory stridor and episodic oxygen desaturation on the third day of life. Laryngomalacia was excluded on initial investigation. Imaging revealed a ductus arteriosus aneurysm that was likely compressing the left recurrent laryngeal nerve, resulting in left-sided vocal cord paralysis. Despite marked respiratory symptoms, the neonate improved spontaneously and was managed conservatively.

This case underscores the importance of considering vascular anomalies - such as a ductus arteriosus aneurysm - in the differential diagnosis of neonatal stridor, particularly when symptoms are progressive or position-dependent. Timely recognition and targeted imaging facilitate accurate diagnosis, prevent unnecessary interventions and enable individualised management.