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March 1997

Radiological Case of the Month

Author Affiliations

From the Department of Pediatrics, Division of Neonatology (Dr Saslow and Mss Lee and Braunschweig) and the Department of Surgery, Division of Cardiothoracic Surgery (Drs Grosso and Courtney), Robert Wood Johnson Medical School, Children's Regional Hospital at Cooper Hospital/University Medical Center, Camden, NJ.

Arch Pediatr Adolesc Med. 1997;151(3):313-314. doi:10.1001/archpedi.1997.02170400099018

A 1700-GRAM male infant was born after 32 weeks of gestation via spontaneous vaginal delivery. He was intubated in the delivery room because of poor respiratory effort and bradycardia. Findings from the initial chest radiograph were interpreted as transient tachypnea of the newborn, and he was rapidly weaned to minimal ventilatory support. After multiple extubation attempts were unsuccessful, he developed marked stridor, severe retractions, decreased bilateral breath sounds, and carbon dioxide retention. Multiple chest radiographs revealed clear lungs with hyperexpansion. Further investigation was undertaken, including bronchoscopy, Doppler echocardiography, barium esophagram (Figure 1), and magnetic resonance imaging (Figure 2). A surgical procedure was performed on day 24 of life.

Denouement and Discussion 

Double Aortic Arch  Vascular rings are rare arterial malformations, occurring with an incidence of less than 1% to 3% of all congenital heart defects.1-3 The most common type of vascular ring is a double aortic arch,4 first