Tracheal vascular ring causing dyspnoea.

Case Report A young man, aged 18, height 72 inches, weight 152 lb. underwent a medical examination late in 1955, prior to entry into the Police. Routine physical examination showed him to be of normal physique, with no skeletal or muscular abnormality. Nothing of note was made out on examination of his cardiovascular and respiratory systems, but he was found to be unduly dyspnceic on exertion, a fact that both the patient and his father had known for several years, and that had caused the patient to forego any strenuous activity. His father could easily outstrip him in a sprint. Because of this dyspnoea he was referred to the Heart Clinic of the Liverpool Royal Infirmary for further investigation. Physical examination again revealed no abnormal features. The blood pressure in both arms was 110/85 mm. of mercury. The femoral pulses were normal. Examination of the heart disclosed no abnormality of size, sounds, or pulsations, and the lungs appeared healthy. No stridor was heard. The electrocardiogram was physiological. The blood count gave normal results and the urine contained no unusual constituents. Radioscopy, however, revealed the presence of a right-sided aortic arch, the cesophagus being displaced anteriorly by a persistent left root (Fig. l). Otherwise the cardiac outline was normal. Further investigation,