A 2-year-old child presents with recurrent stridor and feeding difficulties since infancy. Echocardiography confirms a double aortic arch forming a complete vascular ring. Which chest radiographic finding is MOST suggestive of this diagnosis?

• A Bilateral indentation of the trachea on the lateral view, with narrowing of the tracheal air column at the level of the aortic arch ✓
• B Indentation of the anterior trachea on the lateral view with a right-sided aortic arch on the frontal view
• C A posterior indentation of the esophagus on barium swallow without any tracheal compression on plain radiography
• D A normal chest radiograph, as the diagnosis is made exclusively by echocardiography and CT angiography

Explanation

B double aortic arch forms a complete vascular ring encircling both the trachea and esophagus. On the lateral chest radiograph, this typically produces bilateral indentation on the trachea with narrowing of the tracheal air column at the level of the aortic arch. This finding, combined with symptoms of airway compression, is highly suggestive. Option B describes a right aortic arch with aberrant left subclavian artery (arteria lusoria), which does not form a complete ring. Option C describes an incomplete ring (aberrant subclavian). Option D is incorrect because plain radiography can show tracheal narrowing suggestive of a vascular ring.

Reference: Caffey's Pediatric X-Ray Diagnosis, 12th ed.

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Written and medically reviewed by the StethoPrep medical team.