PMC6350440_01
(a) Computerized tomography angiography with three-dimensional reconstruction showing the double aortic arch with left predominance, (b) site of tracheal stenosis by extrinsic compression, (c) aortic arch in relation to mediastinal structures
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F1
High-resolution computerized tomography (CT) scan revealed a left dominant double aortic arch [Figure 1a] forming a complete vascular ring compressing the trachea just above the carina [Figure 1b]. At the time of radiological evaluation, the endotracheal tube needed to be pulled out proximal to the site of compression to clearly demarcate the site radiologically [Figure 1c].
The site of surgical division (AA: Ascending aorta, RA: Right arch, LA: Left arch, DA: Descending aorta)
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F2
Once all the arch vessels were identified and looped, the right arch was divided from the dominant left arch, just proximal to the origin of the left common carotid artery [Figure 2].