Case reports

Case 1— A 12 year old boy complained of shortness of breath on exercise, worsening over a year, with no other symptoms. Examination was normal. Bronchodilators and inhaled steroids had not helped. Previous investigations included chest radiography, computed tomography of the chest, echocardiography, exercise testing, full lung function tests, measurement of immunoglobulin concentrations, and skin prick testing for allergies. Interstitial lung disease had been suggested on the basis of reduced total lung capacity and residual volume. Review of the original chest x ray film, six months after his initial presentation, showed a right sided aortic arch, with tracheal compression. Repeat spirometry yielded reduced inspiratory and expiratory flow rates, with flattened inspiratory and expiratory flow volume loops. A second echocardiogram along with angiography confirmed a right sided aortic arch with an aberrant left subclavian artery. Bronchoscopy showed narrowing of the distal trachea and right main bronchus. The patient underwent surgery. Constriction of the airway was caused by a ligamentum arteriosum, arising from the first …