International Journal of Contemporary Pediatrics | October 2022 | Vol 9 | Issue 10 Page 972 International Journal of Contemporary Pediatrics Chakraborty A et al. Int J Contemp Pediatr. 2022 Oct;9(10):972-974 http://www.ijpediatrics.com pISSN 2349-3283 | eISSN 2349-3291 Case Report Double aortic arch: a rare cause of wheezing and respiratory distress in infants: a case report Abhishek Chakraborty*, Sanketh R., Ebor Jacob G. James INTRODUCTION Vascular ring reportedly represents less than 1% of all congenital cardiovascular anomalies, but this may be an underestimate because some conditions are asymptomatic. 1 Double aortic arch is the most common vascular ring (40%). 1 Failure of regression of both the right and left fourth branchial arches resulting in right and left aortic arches, respectively. These two arches encircle and compresses trachea and esophagus. Presentation may vary from life threating respiratory distress to asymptomatic condition. CASE REPORT 3 months old, male infant presented with h/o cough and coryza for 1 week and respiratory distress for one day. He was apparently well thrived infant was treated in local hospital as OPD basis with oral bronchodilator and later on with nebulization. However, with worsening of symptoms, he was referred to our hospital. There was h/o intermittent noisy breathing since birth. There was no h/o fever, vomiting or regurgitation of feeds. Past history was uneventful. On examination had tachypnea (RR-65 /min), sub costal retraction, SpO 2 was 91%. On examination of the respiratory system, he had bilateral wheeze. The cardiovascular findings were unremarkable. Baby was otherwise awake. The chest X-ray revealed hyperinflated lung fields bilaterally. He was started on high flow oxygen, inhalation and IV bronchodilator therapy. As his respiratory distress worsened, his respiratory support was upgraded to non-invasive ventilation in the form of nasopharyngeal CPAP. However, despite of all these measures his condition was worsened and on day 3 of PICU admission he was intubated and started on mechanical ventilation. However, after intubation, had rapid improvement in clinical status with minimal ventilator requirements and had no wheeze. So all bronchodilator was tapered and stopped. His tracheal aspirate was examined for respiratory viral PCR and corona virus (not COVID-19) was positive. After 48 hours of invasive ventilation, he was extubated to high flow oxygen. After 24 hours of extubation, his respiratory distress worsened. There was stridor and also worsening of wheeze, not responding to bronchodilator. Baby was again started on non-invasive ventilation (nasopharyngeal CPAP) and adrenaline nebulization was given. Baby gradually improved and after 48 hours he was weaned to high flow oxygen and gradually he was weaned from all types of respiratory support. ABSTRACT Double aortic arch is a rare congenital disorder. Symptoms arises due to compression of trachea or esophagus. Its presentation varies from asymptomatic cases to life threatening respiratory distress. Clinical diagnosis is often difficult due to presence of wide verities of symptoms. We described a three-month-old child presented with wheezing and severe respiratory distress and found to have double aortic arch. Keywords: Double aortic arch, Wheeze, Stridor, Feed intolerance, Treacheal compression Department of Pediatric ICU, Christian Medical College, Vellore, Tamil Nadu, India Received: 03 August 2022 Accepted: 05 September 2022 *Correspondence: Abhishek Chakraborty, E-mail: abhismch12@gmail.com Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. DOI: https://dx.doi.org/10.18203/2349-3291.ijcp20222429