Wheezing and Choking—A Vascular Cause: A Case Report

The double aortic arch is an extremely rare vascular malformation that can be a cause of wheezing episodes and dysphagia in a young child. Depending on the extent of airway compression, anaesthesia management varies. Our patient was a 10-month-old boy with recurrent wheezing and choking episodes. The trachea and oesophagus were compressed by the double aortic arch, and the baby was posted for surgical division of the non-dominant aortic arch. The anaesthesia management is often difficult owing to the airway compression. The anaesthesia management varies from maintaining spontaneous breathing during induction and careful selection of an appropriate endotracheal tube based on the tracheal dimensions to requiring tracheal reconstruction procedures to manage the tracheal stenosis. Intraoperative surgical management depends on the identification of the dominant aortic arch from arterial pressure changes of upper and lower limbs and the repair of associated intra-cardiac defects. We report one such case with a successful outcome. Three-dimensional computed tomography images are attached for a clear understanding of the anatomy. Vascular rings are known, but rare causes of wheezing and choking episodes in a child, which requires careful planning of anaesthesia for a good outcome.