Angiography and dynamic airway evaluation with MDCT in the diagnosis of double aortic arch associated with tracheomalacia.

3Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong. ouble aortic arch is a well-known congenital vascular anomaly causing extrinsic tracheal compression in neonates that can present with life-threatening episodes of stridor, cyanosis, or apnea. Surgical correction of the underlying vascular ring is the key for successful treatment for such patients [1]. However, previous studies have shown that as many as 30% of pediatric patients might still have persistent airway obstruction after surgical procedures [2, 3]. These symptoms may be related to airway wall weakening as a result of long-standing extrinsic airway compression. Such patients may benefit from undergoing a second operation after evaluation with both bronchoscopy and cross-sectional imaging. Recently, MDCT with multiplanar and 3D reconstruction has become an important tool in the evaluation of thoracic aortic anomalies in pediatric patients, obviating conventional angiography [4, 5]. Dynamic inspiratory–expiratory imaging by MDCT has been shown to be a promising method in the evaluation of patients with dynamic airway obstruction and to correlate well with bronchoscopic results [6]. In this case report, we describe the preand postoperative MDCT angiography findings in an infant with double aortic arch who failed extubation after undergoing corrective surgery. A dynamic airway evaluation was performed during the same setting of MDCT angiography by alternately applying and withholding positive-pressure ventilation, which simulated the inspiratory–expiratory scan. The child was found to have tracheomalacia, which explained the airway obstruction that persisted postoperatively.