Lesson of the week: Right sided aortic arch in children with persistent respiratory symptoms

doi:10.1136/bmj.321.7262.687

BMJ 2000;321:687-688 ( 16 September )

Clinical review

Lesson of the week

Right sided aortic arch in children with persistent respiratory symptoms

A chest x ray film may point to an alternative diagnosis in children with persistent asthma

Donald N R Payne, research fellow ^a, Christopher Lincoln, consultant cardiac surgeon ^b, Andrew Bush, reader ^a.

^a Department of Paediatric Respiratory Medicine, Royal Brompton and Harefield NHS Trust, London SW3 6NP, ^b Department of Cardiothoracic Surgery, Royal Brompton and Harefield NHS Trust

Correspondence to: A Bush a.bush@rbh.nthames.nhs.uk

The first 150 words of the full text of this article appear below.

In most children with asthma, symptoms can be controlled with low dose inhaled steroids. Failure to respond should promptother diagnostic considerations, including poor adherence to treatment,an unsatisfactory environment, or psychological factors. Diagnosesother than asthma should also be considered; often, extensiveinvestigations are performed to exclude other diseases. We reporton three children referred with persistent respiratory symptoms.Two of the children had been diagnosed as having asthma, whichwas insensitive to steroids. One of the children was thought tohave interstitial lung disease, but because a radiological signwas missed on his chest x ray film he received inappropriate treatmentand unnecessaryinvestigations.

Case reports

Case 1 $---$ A 12 year old boy complained of shortnessof breath on exercise, worsening over a year, with no other symptoms.Examination was normal. Bronchodilators and inhaled steroids hadnot helped. Previous investigations included chest radiography,computed tomography of the chest, echocardiography, exercise testing,full . . . [Full text of this article]

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