Double aortic arch and tracheal compression

This is an article by Chan MSM et al from Hong Kong, in this month's AJR, that shows how with a single dataset, we can get exquisite angiogram and tracheo-bronchial tree images of a double aortic arch patient. When the patient is under anesthesia, "inspiratory expiratory" images can be obtained to look for concomitant tracheomalacia.

We recently saw a similar patient, where however the tracheal compression was mild to moderate. We could not however perform a dynamic study for tracheomalacia, since all our parients are scanned under deep sedation only.