Respiratory infections and vascular rings

Vascular ring leading to tracheoesophageal compression in a patient with Rubinstein-Taybi syndrome

Mediastinal vascular rings cause tracheoesophageal obstruction, resulting in respiratory symptoms and dysphagia in children. Although a large number of children with Rubinstein-Taybi syndrome have frequent respiratory infections and feeding difficulties, there has been no firmly established association between this syndrome and the occurrence of vascular rings. We report on a patient with Rubinstein-Taybi syndrome who had a vascular ring. Since there was a previous report of a similar ring in a child with Rubinstein-Taybi syndrome, we suggest there may be an association between Rubinstein-Taybi syndrome and vascular rings.

[Vascular tracheal compression presenting as bronchiolitis in infants]

BACKGROUND

Anomalies of the aortic arch and pulmonary arteries may produce compression of the trachea with chronic stridor or wheezing aggravated by crying, feeding and flexion of the neck.

CASE REPORTS

Three infants, 3, 5 and 2 months-old, respectively, were admitted suffering from acute bronchiolitis. The first patient had intermittent wheezing for one month; lateral chest X-rays showed an opaque area inserted between the trachea and oesophagus and computed tomography showed pulmonary artery sling with tracheal stenosis which was successfully operated. The second patient displayed pulmonary atelectasia which required bronchoscopy; this technique showed tracheal stenosis which was due to pulmonary artery sling. The third patient had a history of congenital stridor: he required endotracheal intubation; a bronchoscopy performed because persistent pulmonary atelectasia showed tracheal stenosis which was secondary to a double aortic arch. The condition was improved after surgical correction.

CONCLUSIONS

A history of stridor and/or wheezing in patients admitted for bronchiolitis must lead to consider the possibility of vascular compression of the trachea and to perform specific investigations.