The barium swallow will show circumferential narrowing. Treatment consists of surgically dividing the ring, generally by ligating the smaller of the 2 aortic arches. A pulmonary artery sling also is known as an aberrant left pulmonary artery. In these cases, the left pulmonary artery passes between the trachea and esophagus, resulting in distal tracheal and right bronchus compression. It is associated with the presence of complete tracheal rings.
Treatment involves surgical rerouting of the aberrant vessel.
Other vascular anomalies exist as well. For example, if a right aortic arch is present with a persistent ligamentum arteriosum, symptoms will be similar to those of a double aortic arch. Also, an anomalous subclavian artery may compress the airway if it courses immediately anteriorly or posteriorly to the trachea. When a complete tracheal ring exists, no membranous portion of the trachea is present, leaving only a rigid nonflexible case around the airway. Symptoms include dyspnea and possibly stridor, which are particularly exacerbated with upper respiratory infections.