Double Trouble: Unwrapping the Cause of Recurrent Respiratory Distress in an Infant
Document Type
Conference Proceeding - Restricted Access
Publication Date
5-9-2025
Abstract
A 4-month-old term, SGA female with poor weight gain presented with increased work of breathing. She was discharged 6 days prior from an outside hospital where she received NIPPV, heliox, and amoxicillin for CAP and rhino/enterovirus PNA. Her work of breathing never returned to baseline. Postnatal echocardiogram on DOL 1 demonstrated normal intracardiac anatomy and function, unobstructed flow in aortic arch, PFO with left-to-right shunt.
Presented to ED with dyspnea and cough. Afebrile and SpO2 100% on room air. Exam with mild tachypnea, stridor, subcostal retractions and wheezing. Placed on 1L/kg HFNC and transferred for presumed viral bronchiolitis. Initial CBC, CMP, CRP, and procalcitonin were unremarkable. Viral testing was unchanged. CXR showed peribronchial thickening.
Required up to 2L/kg HFNC with inability to successfully wean over 7 days. Received 5 days of Augmentin with concern for prior failed CAP treatment. Work of breathing continued to worsen prompting transfer to the PICU. Airway clearance regimen was optimized in addition to steroids and albuterol to cover for possible reactive airway disease component. Bronchoscopy and direct laryngoscopy revealed significant vascular compression of the distal trachea and right mainstem bronchus in addition to tight arytenoepiglottic folds. Echocardiogram demonstrated a right dominant double aortic arch, and she ultimately underwent surgical repair after recovering from multiple viral illnesses.
Bronchiolitis is the most common cause of increased work of breathing during infancy; however, it is important to consider alternative diagnoses to not miss underlying cardiac disease or anatomic abnormalities. Vascular rings are congenital anomalies of the aortic arch causing compression of the esophagus, trachea, or bronchial tree. Most common symptoms include stridor, wheezing, cough, respiratory distress, frequent respiratory infections, dysphagia and/or feeding difficulties. Vascular rings are usually formed by either double aortic arch or a right aortic arch with
Recommended Citation
Brackmann M, Lemmen M, Hadley A. Double trouble: Unwrapping the cause of recurrent respiratory distress in an infant. Presented at: Research Day Corewell Health West; 2025 May 9; Grand Rapids, MI.
Comments
2025 Research Day Corewell Health West, Grand Rapids, MI, May 9, 2025. Abstract 1719