Abstract
INTRODUCTION: Aberrant right subclavian artery (ARSA) is the most common congenital anomaly of the subclavian artery, occurring in 0.2%-1.5% of the population. While typically asymptomatic, ARSA can cause dysphagia in older patients due to esophageal compression. In pediatric cases, it is less frequent and usually presents with chronic respiratory symptoms resulting from tracheal compression. Acute respiratory failure as a presentation of ARSA is extremely rare. This case report describes a pediatric patient with ARSA-associated esophageal stricture, leading to severe respiratory distress following food intake and requiring surgical treatment. CASE PRESENTATION: A 1.8-year-old girl developed an inspiratory stridor after eating. Initial inhalation therapy provided temporary relief, but persistent respiratory distress prompted further evaluation. CT revealed an esophageal foreign body, which was successfully extracted using a balloon catheter. However, continued respiratory distress necessitated intubation and intensive care. Bronchoscopy and enhanced CT confirmed tracheal compression due to ARSA, along with esophageal stenosis. Despite initial medical management, recurrent respiratory distress and feeding difficulties required surgical intervention. A right thoracotomy was performed to reposition the aberrant artery anterior to the trachea, alleviating the vascular compression. Postoperatively, the patient made a full recovery, resumed a normal diet, and remained symptom-free at the 6-month follow-up. CONCLUSIONS: Symptomatic ARSA is rare in pediatric patients but can cause severe respiratory distress due to esophageal and tracheal compression. In cases of recurrent or severe symptoms, surgical intervention is essential to prevent life-threatening complications. This case highlights the importance of considering ARSA in pediatric patients with unexplained respiratory distress, especially when associated with feeding difficulties.