Double aortic arch in an infant treated surgically.

Among the causes of respiratory distress in infants and children must be included the interesting developmental anomalies of large arteries in the superior mediastinum. The tracheal compression which may result can cause respiratory disturbances such as dyspnoea, tachypnoea, and inspiratory retraction of the chest wall, as well as " wheeziness" or stridor. These disturbances are likely to be intensified by respiratory infection. This common and often recurrent complication, which can prove lethal, may mistakenly be considered to be the primary disorder. If the vascular anomaly is suspected a precise diagnosis can usually be made by radiological examination as described by Neuhauser (1946). It is important to make the diagnosis, because operation offers a cure. A detailed account of this group of arterial anomalies was given by Quain (1844), who illustrated a case of double aortic arch originally described in 1737 by Hommel, an assistant of Haller. Gross (1955) has reported inter alia 26 patients with this abnormality. As far as we are aware, in this country only five clinical reports of the anomaly have appeared (Stevenson, 1950; Dolton and Jones, 1952; d'Abreu, Astley, and Parkes, 1952; Smithells, 1953; Jones and Walker, 1955). A further case, with dramatic improvement after surgical intervention, is described below.