Stridor at birth: a diagnostic dilemma


  • Rajparath Ragu Department of Neonatology, Cloudnine Hospital, Chennai, Tamil Nadu, India
  • Ramkumaar U. Department of Neonatology, Cloudnine Hospital, Chennai, Tamil Nadu, India



Double aortic arch, Respiratory distress, Stridor, Vascular ring


Stridor is a common complaint in neonates. Double aortic arch (DAA) is a congenital anomaly of the aortic arch. It is the most common type of complete vascular ring. When it occurs, the connected segment of the aortic arch and its branches encircle the trachea and esophagus, leading to symptoms related to these two structures. Association with respiratory distress mandates early flexible bronchoscopic examination of the airway. We report here the diagnosis and management of a neonate with double aortic arch that presented as stridor at birth. Persistence of stridor after surgery and its management was highlighted.



Chan YT, Ng DK, Chong AS, Ho JC. Case Report Double Aortic Arch Presenting as Neonatal Stridor. HK J Paediatr. 2003;8(2):126-9.

Cesnjevar R, Harig F, Purbujo A, Cuomo M, Blumauer R, Münch F, Alkassar M, Dittrich S. Tracheobronchial Compression by Congenital Vascular Anomalies-Surgical Procedures and Results. Thorac Cardio Surg. 2020;68(S1):1-72.

Mong DA. Pediatric Thoracic Radiology. In:Pretorius ES and Solomon JA, eds. Radiology Secrets Plus. 3rd ed.Elsevir; 2011;413-7.

Priya S, Thomas R, Nagpal P, Sharma A, Steigner M. Congenital anomalies of the aortic arch. Cardiovasc Diagn Ther. 2018;8(S1):26-44.

Tarmahomed A, Umapathi KK. Double Aortic Arch. StatPearls. 2020.

Hanneman K, Newman B, Chan F. Congenital variants and anomalies of the aortic arch. Radiographics. 2017;37(1):32-51.

Galindo A, Nieto O, Nieto MT, Rodríguez-Martín MO, Herraiz I, Escribano D, Granados MA. Prenatal diagnosis of right aortic arch: associated findings, pregnancy outcome, and clinical significance of vascular rings. Prenat Diagn. 2009;29(10):975-81.

Bravo C, Gámez F, Pérez R, Álvarez T, De León-Luis J. Fetal Aortic Arch Anomalies: Key Sonographic Views for Their Differential Diagnosis and Clinical Implications Using the Cardiovascular System Sonographic Evaluation Protocol. J Ultrasound Med. 2016;35(2):237-51.

Razon Y, Berant M, Fogelman R, Amir G, Birk E. Prenatal diagnosis and outcome of right aortic arch without significant intracardiac anomaly. J Am Soc Echocardiogr. 2014;27(12):1352-8.

Jain S, Kleiner B, Moon-Grady A, Hornberger LK. Prenatal diagnosis of vascular rings. J Ultrasound Med. 2010;29(2):287-94.

Daniel M, Cheng A. Neonatal stridor. Int J Pediatr. 2012;2012:859104.

Mądry W, Karolczak MA, Myszkowski M, Zacharska-Kokot E. Non-invasive diagnosis of aortic arch anomalies in children–15 years of own experience. J Ultrason. 2019;19(76):5-8.

Umegaki T, Sumi C, Nishi K, Ikeda S, Shingu K. Airway management in an infant with double aortic arch. J Anesth. 2010;24(1):117-20.

Sahni D, Franklin WH. Vascular Ring Double Aortic Arch. Stat Pearls. 2020.

Ganie IS, Amod K, Reddy D. Vascular rings: a radiological review of anatomical variations. Cardiovascular journal of Africa. 2015;27(1):30-6.






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