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A six-month-old boy who had recurrent respiratory difficulties was admitted to the hospital with acute respiratory failure that required mechanical ventilation. Echocardiography suggested the presence of a double aortic arch. Magnetic resonance imaging confirmed the diagnosis of a double aortic arch (Panel A; Ao denotes aorta, E esophagus, and Tr trachea). The trachea and esophagus were seen to run through the vascular ring of the two aortic arches (Panel B). High-grade stenosis of the trachea was identified. Surgical correction was performed, and the left arch was determined to be slightly hypoplastic. This arch was ligated distal to the left subclavian artery. Two years after the surgical correction, the child is doing well.
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