A case of double aortic arch suggested by the analysis of the flow-volume curve

A twenty-one year old female with a history of recurrent pneumonia and airway infections since infancy, chronic cough, gastroesophageal reflux symptoms, and persistent allergic rhinitis was referred to our asthmatic centre. She exhibited a normal sweat test, skin prick test positive to common allergens, and gastroscopy showing hiatal hernia and reflux esophagitis. We performed spirometry for the first time. The flow-volume curve showed a plateau of forced expiratory flow suggesting a variable intrathoracic airway obstruction. We then carried out bronchoscopy that showed a compression of the distal trachea. A computed tomography angiogram revealed a vascular ring consisting of a double aortic arch with right-arch dominance compressing the trachea and esophagus. Echocardiography confirmed the presence of the vascular ring. The patient has been referred for surgery. This report underscores the importance of spirometry and the analysis of the flow-volume curve morphology in the evaluation of patients with respiratory symptoms.