A bit of a mix-up: Right-sided aortic arch

Case presentation

A 7-week-old male presents with difficulty breathing while feeding for 1 day. The child is formula fed 3 ounces every 3–4 hours, but over the past 2–3 days, he has been feeding every 4 hours and not completing the 3 ounces. One day ago, he developed increased work of breathing while feeding and “turned pale for several seconds” according to the parents. There was no associated tonic-clonic activity with this event and the child did not stop breathing. This continued with most of the feeds during the day but otherwise there were no other concerns. On the day of presentation, he “turned blue for a few seconds” while feeding. With these episodes, the mother reports nasal congestion and copious oral secretions (with some formula) that she has been suctioning with a bulb syringe. There has been no fever, vomiting, diarrhea, rash, or known trauma, and the child is reported otherwise to be at his baseline.

The child recently arrived from Central America. The parents report the child has not had problems with breathing or feeding in the past and has “been healthy.” There was little prenatal care but the mother was told the child “had a heart problem” on a prenatal ultrasound, but she did not understand what the issue was and was told “nothing could be done.” Aside from this, the parents report no other concerns or problems. They have not yet been to a local pediatrician.

The physical examination reveals an overall well-appearing, vigorous child who is in no acute distress. He is afebrile with a heart rate of 170 beats per minute, respiratory rate of 45 breaths per minute, and a pulse oximetry reading of 100% on room air. He has a completely normal examination; his cardiac examination demonstrates no heart murmur, rub, or click; he has equal pulses throughout and is well perfused.

Imaging considerations