Vascular cause for stridor in infants.

Case presentation A 6-month-old infant presented with a longstanding persistent cough, episodic spells of shortness of breath, gasping-like efforts after feeding, and an unusual noise while breathing, and was reported to have turned blue on two occasions after feeding. A chest X-ray showed significant narrowing of the trachea 2 cm above the carina. An upper gastro-intestinal study (Fig. 1) showed anterior bowing and extrinsic compression of the posterior wall of the oesophagus at the mid-thoracic level, and the trachea was narrowed and showed anterior bowing. The differential diagnosis included an aberrant right subclavian artery, and a double aortic arch was suspected. A thoracic computed tomography (CT) angiogram (Fig. 2) confirmed the presence of a vascular ring created by a double-sided aortic arch with compression of the trachea and oesophagus.