Stridor and Dysphagia Unmasking an Aberrant Right Subclavian Artery in a Toddler

A one-year-old girl presented with acute-onset dyspnea persistent for two days and recurrent choking episodes. Physical examination revealed stridor and sub-costal retractions. Despite initial treatment with inhaled nebulized epinephrine, stridor persisted. Lateral chest radiography finding indicated tracheal stenosis. Contrast-enhanced neck and chest computed tomography (CT) showed an aberrant right subclavian artery compressing the esophagus posteriorly, causing esophageal stenosis with associated food residue accumulation. The proximally dilated portion of the esophagus caused mass effect with compression of the trachea, resulting in tracheal stenosis. Despite medical management, the patient experienced recurrent stridor and could only swallow liquids. Therefore, surgical translocation of the right subclavian artery to the right common carotid artery was performed. Postoperatively, the patient swallowed age-appropriate food, and the stridor resolved.

The most common cause of stridor in children is viral croup, which is typically treated with nebulized epinephrine and corticosteroids in moderate to severe cases. However, recurrent or persistent stridor with dysphagia should raise concern for vascular anomalies (eg, aberrant right subclavian artery), bacterial tracheitis, epiglottitis, retropharyngeal abscess, foreign body aspiration, mediastinal tumors, or other compressive pathologies. Early symptomatic presentation with dysphagia and stridor in young children is unusual, as aberrant right subclavian artery symptoms typically develop after age 40. When clinical presentation deviates from typical croup, particularly if associated with dysphagia, ultrasound, magnetic resonance imaging, or contrast-enhanced CT can identify vascular anomalies. Surgical intervention is indicated for symptomatic aberrant right subclavian artery when symptoms persist despite medical management (nutrition monitoring, feeding support, airway support, and growth assessment).