Diagnostic Challenges of Vascular Rings: Insights from a Case Report
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Abstract
The vascular ring (VR) is a rare congenital anomaly that can cause compression of the trachea or esophagus, resulting in respiratory and/or gastrointestinal symptoms. The severity of symptoms depends on the type of VR, with patients who have anatomically complete VRs typically presenting earlier in life. The diagnosis of VR has advanced with the availability of improved imaging modalities. Prenatal diagnosis is possible with fetal echocardiogram, while non-invasive multidetector CT and MRA can be utilized for later diagnosis. These imaging modalities allow for the delimitation of the defect and the identification of the anatomy for treatment planning.
This case report presents the evaluation and management of a male neonate who was diagnosed with VR after initially presenting with respiratory and gastrointestinal symptoms that were suspected to be related to gastroesophageal reflux. This case highlights the importance of considering VR in the differential diagnosis of patients presenting with these symptomatologies.
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References
I. Yoshimura, N., Fukahara, K., Yamashita, A., Doi, T., Yamashita, S., Homma, T., Yokoyama, S., Aoki, M., Higashida, A., Shimada, Y., Toritsuka, D., Nagao, K., & Ikeno, Y. (2020). Congenital vascular ring. Surgery Today, 50(10), 1151–1158. https://doi.org/10.1007/s00595-019-01907-5
II. Ruiz-Solano, E., & Mitchell, M. (2022). Rings and Slings: Not Such Simple Things. Current Cardiology Reports, 24(10), 1495–1503. https://doi.org/10.1007/s11886-022-01764-8
III. Licari, A., Manca, E., Rispoli, G. A., Mannarino, S., Pelizzo, G., & Marseglia, G. L. (2015). Congenital vascular rings: A clinical challenge for the pediatrician: Congenital Vascular Rings: A Clinical Challenge. Pediatric Pulmonology, 50(5), 511–524. https://doi.org/10.1002/ppul.23152
IV. Biermann, D., Holst, T., Hüners, I., Rickers, C., Kehl, T., Rüffer, A., Sachweh, J. S., & Hazekamp, M. G. (2021). Right aortic arch forming a true vascular ring: A clinical review. European Journal of Cardio-Thoracic Surgery, 60(5), 1014–1021. https://doi.org/10.1093/ejcts/ezab225
V. Priya, S., Thomas, R., Nagpal, P., Sharma, A., & Steigner, M. (2018). Congenital anomalies of the aortic arch. Cardiovascular Diagnosis and Therapy, 8(S1), S26–S44.
https://doi.org/10.21037/cdt.2017.10.15
VI. Hanneman, K., Newman, B., & Chan, F. (2017). Congenital Variants and Anomalies of the Aortic Arch. RadioGraphics, 37(1), 32–51. https://doi.org/10.1148/rg.2017160033
VII. Edwards, J. E. (1948). Anomalies of the Derivatives of the Aortic Arch System. Medical Clinics of North America, 32(4), 925–949. https://doi.org/10.1016/S0025-7125(16)35662-0
VIII. Russell, H. M., & Backer, C. L. (2010). Pediatric Thoracic Problems: Patent Ductus Arteriosus, Vascular Rings, Congenital Tracheal Stenosis, and Pectus Deformities. Surgical Clinics of North America, 90(5), 1091–1113. https://doi.org/10.1016/j.suc.2010.06.009
IX. Dillman, J. R., Attili, A. K., Agarwal, P. P., Dorfman, A. L., Hernandez, R. J., & Strouse, P. J. (2011). Common and uncommon vascular rings and slings: A multi-modality review. Pediatric Radiology, 41(11), 1440–1454. https://doi.org/10.1007/s00247-011-2131-2
X. Atkins, M. D., & Fuller, S. (2018). Thoracic Surgery Considerations in the Child and Young Adult. Thoracic Surgery Clinics, 28(1), 43–52. https://doi.org/10.1016/j.thorsurg.2017.08.005
XI. Evans, W. N., Acherman, R. J., Ciccolo, M. L., Carrillo, S. A., Mayman, G. A., Luna, C. F., Rollins, R. C., Castillo, W. J., & Restrepo, H. (2016). Vascular Ring Diagnosis and Management: Notable Trends Over 25 Years. World Journal for Pediatric and Congenital Heart Surgery, 7(6), 717–720. https://doi.org/10.1177/2150135116661279
XII. Zmora, O., Beloosesky, R., Khatib, N., Ginsberg, Y., Khoury, A., & Bronshtein, M. (2021). Early Prenatal Diagnosis of Double Aortic Arch: Prevalence, Associated Anomalies and Outcome. Ultraschall in der Medizin - European Journal of Ultrasound, 42(05), 529–532. https://doi.org/10.1055/a-1132-5402
XIII. Hunter, L., Callaghan, N., Patel, K., Rinaldi, L., Bellsham-Revell, H., & Sharland, G. (2015). Prenatal echocardiographic diagnosis of double aortic arch: Double aortic arch in the fetus. Ultrasound in Obstetrics & Gynecology, 45(4), 483–485. https://doi.org/10.1002/uog.13408
XIV. García-Guereta, L., García-Cerro, E., & Bret-Zurita, M. (2016). Multidetector Computed Tomography for Congenital Anomalies of the Aortic Arch: Vascular Rings. Revista Española de Cardiología (English Edition), 69(7), 681–693. https://doi.org/10.1016/j.rec.2016.03.025
XV. Tola, H., Ozturk, E., Yildiz, O., Erek, E., Haydin, S., Turkvatan, A., Ergul, Y., Guzeltas, A., & Bakir, I. (2017). Assessment of children with vascular ring. Pediatrics International, 59(2), 134–140. https://doi.org/10.1111/ped.13101