Two Arches, One Airway, Zero Room to Breathe: A Case of Laryngeal Cancer and Double Aortic Arch

Document Type

Conference Proceeding

Publication Date

5-1-2025

Publication Title

Am J Respir Crit Care Med

Keywords

carboplatin, paclitaxel, adult, aortic arch, balloon dilatation, blood pressure, brachytherapy, bronchoscopy, case report, clinical article, computer assisted tomography, conference abstract, congenital blood vessel malformation, congenital heart disease, CT guided biopsy, diagnosis, dyspnea, endotracheal tube, erythema, esophagogastroduodenoscopy, esophagus balloon, fiberoptic bronchoscopy, fine needle aspiration biopsy, gastrointestinal discomfort, heart rate, human, hypertension, intubation, larynx cancer, larynx squamous cell carcinoma, male, middle aged, nasogastric tube, neck swelling, respiratory distress, squamous cell carcinoma, stridor, surgery, therapy, vascular ring

Abstract

Introduction: A double aortic arch (DAA) is a congenital vascular malformation in which the presence of two aortic arches forms a complete vascular ring. A DAA can be further subcategorized to right dominant aortic arch (25%), left dominant (20%), and balanced type (5%). Clinical symptoms typically develop within the first six months of life, as compression of the trachea and/or esophagus causes respiratory and/or gastrointestinal symptoms. Here, we present a case of a patient with recurrence of laryngeal squamous cell carcinoma that was found to have a double aortic arch in the setting of respiratory distress. Case Description: A 49-year-old male with history of T2 laryngeal squamous cell carcinoma receiving chemoradiation and hypertension presented for elective computed tomography (CT) guided biopsy. Upon arrival, he was afebrile with a blood pressure of 192/116mmHg, and heart rate of 107. He appeared dyspneic with audible stridor and neck swelling. CT thorax identified a double aortic arch with tracheoesophageal compression. Due to the increased risk of airway compromise he underwent bedside fiberoptic intubation. Bronchoscopy revealed hyperdynamic and erythematous trachea. Narrowing of the endotracheal tube was noted several centimeters above carina due to external compression from a paralaryngeal mass. Esophagogastroduodenoscopy (EGD) showed no evidence of penetrating esophageal mass or stricture. Esophageal balloon dilation was performed for nasogastric tube placement. CT guided fine needle biopsy of the paralaryngeal mass revealed invasive moderately differentiated squamous cell carcinoma histologically similar to the patient's prior laryngeal cancer. One dose of emergent chemotherapy with carboplatin and paclitaxel was administered. Due to the complex nature of the case the patient was transferred to the University of Michigan for evaluation by ENT oncology for resection and brachytherapy. Discussion: Double aortic arches are an extremely rare congenital malformation, occurring in 1 in 15,000 births and accounting for 1% of all congenital heart diseases. Most cases are typically diagnosed in childhood and often managed with surgical division of the minor arch. Here we discuss the case of an adult male with dual compromise of his airway by both laryngeal cancer and a double aortic arch vascular ring. This compromise made airway management challenging necessitating bedside fiberoptic bronchoscopy for intubation. Additionally, due to compromise of the esophagus an EGD with esophageal balloon dilation was required for passage of a nasogastric tube. These interventions were vital in stabilizing the patient's airway while a final surgical plan could be cultivated.

Volume

211

Issue

Supplement 1

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