title: Recurrent respiratory infections caused by a double aortic arch: The diagnostic role of spirometry.
abstract: A young woman with a clinical history characterized by recurrent respiratory infections, occurring since early infancy, was referred to our hospital. When the patient was a young girl, she underwent sweat chloride test, serum analysis of immunoglobulins, and evaluation of blood lymphocyte subsets; all these diagnostic tests were normal, as well as chest X ray aside from pneumonia episodes. Skin prick tests were positive for several different allergens, and a diagnosis of allergic rhinitis was made. At the age of 11 years, she started to complain of gastroesophageal reflux disease (GERD) symptoms, and a gastroscopy detected a hiatal hernia with esophagitis. Despite pharmacologic treatments for allergic rhinitis and GERD, the patient continued to complain of chronic cough, associated with choking and recurrent respiratory infections treated with antibiotic therapy. For the first time in her life, we performed a spirometry that showed a flow-volume curve characterized by a plateau in the expiratory phase, suggestive of an central airway obstruction. Bronchoscopy demonstrated a compression of the distal portion of trachea. Computed tomography (CT) angiogram revealed a double aortic arch. Barium enhancement evidenced an esophageal compression. A surgical division of the smaller of the two arches was then performed. Therefore, we strongly suggest to perform lung function tests in all cases of unexplained respiratory complaints.
authors.affiliation: Dipartimento di Scienze Cardiotoraciche e Respiratorie, Seconda Università degli Studi di Napoli, Azienda Ospedaliera dei Colli-Plesso Monaldi, via Leonardo Bianchi, 80131 Napoli, Italy.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Calabrese
authors.affiliation: Dipartimento di Scienze Cardiotoraciche e Respiratorie, Seconda Università degli Studi di Napoli, Azienda Ospedaliera dei Colli-Plesso Monaldi, via Leonardo Bianchi, 80131 Napoli, Italy.
authors.forename: Nadia
authors.initials: N
authors.lastname: Corcione
authors.affiliation: Dipartimento di Scienze Cardiotoraciche e Respiratorie, Seconda Università degli Studi di Napoli, Azienda Ospedaliera dei Colli-Plesso Monaldi, via Leonardo Bianchi, 80131 Napoli, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Di Spirito
authors.affiliation: UOC di Broncologia, Azienda Ospedaliera dei Colli-Plesso Monaldi, via Leonardo Bianchi, 80131 Napoli, Italy.
authors.forename: Carmine
authors.initials: C
authors.lastname: Guarino
authors.affiliation: UOC di Broncologia, Azienda Ospedaliera dei Colli-Plesso Monaldi, via Leonardo Bianchi, 80131 Napoli, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Rossi
authors.affiliation: Dipartimento Cardiovascolare, Università degli Studi di Bologna, Azienda Ospedaliero-Universitaria S.Orsola-Malpighi, Bologna, Italy.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Domenico Gargiulo
authors.affiliation: Dipartimento di Medicina e Chirurgia, Università degli Studi di Salerno, Via S. Allende, 84081 Baronissi, Salerno, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Vatrella
keywords: Central airway obstruction; Double aortic arch; Gastro-esophageal reflux symptoms; Respiratory infections; Spirometry; Vascular rings