The Lord of Ring: Neonatal Collapse Consequent to Ductal Aneurysm Complicating Double Aortic Arch

Abstract

A term, nondysmorphic female neonate, delivered normally after an uneventful pregnancy, developed severe biphasic stridor from the first cry. Point-of-care ultrasound (POCUS) within 30 min of life showed concordant cardiac connections and suprasternal view displayed an isolated vascular ring but was technically difficult due to stridor. Due to rapid deterioration, instant endotracheal intubation with positive pressure ventilation was initiated. Postintubation, the neonate improved immediately. The hyperechogenic tube splinted the trachea and acted as a clear roadmap delineating the components of the double aortic arch. Contrast-enhanced computed tomography aortogram validated the echocardiography findings. The baby was successfully operated on with an excellent outcome. This case illustrates the utilization of inexpensive bedside equipment during POCUS in resource-limited setups to diagnose the rarest neonatal cardiac lesions, which could be otherwise life-threatening.

Keywords

• double aortic arch
• ductal aneurysm
• point-of-care ultrasound
• vascular ring