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. Diagnosis may be made by CT scan or rigid bronchoscopy, where the complete ring may be seen to involve a single tracheal segment, multiple segments, or even the entire length of the trachea.
Treatment consists of surgery.
Absent or deformed tracheal cartilage rings also can occur, with resulting poor local structural support of the airway in the affected areas. Diagnosis is made by rigid bronchoscopy, where flaccid segments may be seen and palpated. Treatment involves watchful waiting only, as symptoms will resolve with tracheal growth as the diameter of the tracheal lumen increases. Symptoms of a TEF include aspiration and dyspnea or frank respiratory distress during feeding. Diagnosis may be suggested by failure to pass a nasogastric tube.