Imaging recommendation · Chest

Pediatric stridor + dysphagia, suspected vascular ring

Q: What's the alternative imaging for pediatric stridor + dysphagia, suspected vascular ring when bronchoscopy for airway assessment?

Direct laryngoscopy / bronchoscopy (no contrast).

Recommended: Esophagram + CTA Chest is the preferred imaging study for pediatric stridor + dysphagia, suspected vascular ring. Double aortic arch, right aortic arch with aberrant left subclavian + left ductus, or pulmonary artery sling.

Recommended study

Esophagram + CTA Chest

CT IV contrast Preferred Chest OutpatientAcute inpatient Reviewed 2026-05

Double aortic arch, right aortic arch with aberrant left subclavian + left ductus, or pulmonary artery sling.

If the default doesn't apply

Bronchoscopy for airway assessment

Direct laryngoscopy / bronchoscopy No contrast

Watch-outs

Pulmonary artery sling + tracheal stenosis

Associated complete tracheal rings — image airway carefully.

Pearls

Esophagram: posterior indentation suggests aberrant subclavian or double arch.
Double aortic arch is most common symptomatic vascular ring.
Surgical division of the smaller arch / ligamentum arteriosum is curative.