Congenital Stridor Caused by an Aberrant Pulmonary Artery

The patient was a boy, the youngest of three children, the others having had no relevant illnesses. He was delivered normally at term. During the first two weeks after birth he had been well, but then developed a wheeziness which was constantly present although varying in intensity. This variation bore no relation to feeding, and he did not regurgitate his feeds. He was admitted to another hospital at the age of 4 months with an acute respiratory infection diagnosed as tracheo-bronchitis. This resolved within a week, but the child remained wheezy. At the age of 5 months he was admitted to Ruchill Hospital having developed another attack of acute respiratory distress during the preceding 24 hours. There was marked stridor with indrawing of the lower intercostal spaces and supraclavicular fossae. Expiratory wheezing was more marked than inspiratory. Percussion of the chest was normal. On auscultation, coarse crepitations were heard throughout both lungs. The lungs were clear radiologically. Acute tracheo-bronchitis was diagnosed. He was placed in a steam tent and treatment with aureomycin, 50 mg. every six hours, was begun. The temperature, which had been 101 . 20 F. on admission, was normal within 24 hours, and the child's condition was sufficiently improved within 48 hours for him to be removed from the steam tent. On the sixth day aureomycin was discontinued. The child by then was fairly lively. He had shown no reluctance to feed, and no exacerbation of his symptoms was associated with feeding. Wheeziness, however, remained but was now confined to expiration. During sleep it was almost inaudible. The history was, of course, suggestive of an anomaly of the great vessels causing compression of the trachea. When the child was sufficiently well, investigations were begun. Laryngoscopy was normal. No narrowing of the trachea could be seen radiologically on the posteroanterior and lateral views of the chest, but the trachea was not outlined with iodized oil for fear of precipitating a further acute respiratory infection. Unfortunately, as the child would not cooperate, it was difficult to get satisfactory radiographs of the barium-outlined oesophagus. The films obtained excluded gross compression or deviation but were not of sufficient quality to show minor indentations. Further examination was about to be made but was prevented by the child's developing a recurrence of the illness which had originally led to his admission. He was then 6 months old. He was seen by Mr. R. S. Barclay and transferred to the Thoracic Surgical Unit at Mearnskirk Hospital. The diagnosis of a vascular anomaly had not yet been established but the