vascular ring in an adolescent patient with nausea and

Lehigh Valley Health NetworkLVHN Scholarly Works

Department of Pediatrics

Vascular Ring in an Adolescent Patient with Nauseaand Mild DysphagiaKristen Kametz CRNPLehigh Valley Health Network, Kristen_P.Kametz@lvhn.org

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Published In/Presented AtKametz, K. (2015, October 7). Vascular Ring in an Adolescent Patient with Nausea and Mild Dysphagia. Poster presented at: NationalConference for NASPGHAN (North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, Washington, DC.

Case Presentation Discussion

•Vascularringsaregeneticanomaliesthatpresentininfantswithrespiratorydifficultiesandabnormalities,buttheyshouldalsobeconsideredwhenapatientpresentswithpersistentnauseaandvomitingatanyage.

•Itisimportanttodothoroughhistorytakingwhenseeingapatientinordertodeterminetheappropriatetesting

© 2015 Lehigh Valley Health Network

Conclusions

•Vascularringsshouldbeconsideredpartofthedifferentialforpatientsofallageswhopresentwithpersistentnauseaand/orvomiting.

•Oralcontraststudiessuchasabariumesophagramareanimportanttestindetermininganatomicabnormalitiesinpatients.

•13yroldotherwisehealthymalepresentedtotheclinicwith8monthsofearlymorningnauseaandintermittentnon-bloody,non-biliousemesis.Symptomswerenotassociatedwithfoodoractivity.Complaintofmilddysphagiawithbreads,butotherwisepatientdeniedabdominalpain,dyspepsia,abnormalbowelmovements,weightlossorchangeinappetite.

•Patientwasplacedonomeprazole20mgoncedailywithmildimprovementofnausea.

•Labsobtained-TTGIGA,IGA,TSH,T4,lipase,amylase,chemistrypanel,completebloodcountandsedimentationratewereallunremarkable.

•BariumEsophagramshowing:Right-sidedaorticarchwithaberrantleftsubclavianartery.Otherwise,normalesophagus,stomach,andduodenum.

•CardiacMRI–withandwithoutIVcontrastshowedrightaorticarchwithaberrantleftsubclavianarteryoriginatingfromaretroesophagealdiverticulum.Thisanatomicsubstrateconstitutesavascularring.Thereisassociatednarrowingatthelevelofthering.Thereisalsonarrowingoftherightmainstembronchusasitcoursesunderneaththerightaorticarch.

•Cardiothoracicsurgeryultimatelyperformedthoracicsurgerytolitigatethering.

•Aftersurgerypatientdeniesgastrointestinalcomplaints,includingnauseaandvomiting.Henolongerrequiresmedication.

Introduction•Vascularringsareacongenitalanomalythatcancausegastrointestinalandrespiratorysymptomsduetocompressionofthe

esophagusandtrachea.Thevascularringcancomprisearightsidedaorticarch,leftsubclavianarteryandaleftligamentum.•Itisararecauseofdysphagiainadolescentpatients.

Imaging

BariumEsophagram

Pediatric Gastroenterology, Children’s Hospital of Lehigh Valley Hospital and Health Network, Allentown, PA

Vascular Ring in an Adolescent Patient with Nausea and Mild Dysphagia Kristen Kametz, CRNP