Post-traumatic dissecting aneurysm in a child presenting with stridor: A diagnostic dilemma

Abstract

Introduction: Stridor is one of the common presentations of children admitting to emergency department with respiratory distress. The most common etiology of stridor in pediatric age group is infective pathology or ingestion of foreign body. The presentation of dissecting aneurysm causing stridor in pediatric population is very rare and has never been reported in the literature. Case Presentation: A 14-year-old boy presented to the Emergency Department with sub-acute onset of stridor after fall from height on an uneven surface. A suspicion of foreign body or an infective pathology was made and the child was shifted to the operating room. After performing a successful intubation under general anesthesia, diagnostic rigid bronchoscopy and esophagoscopy were done which revealed a pulsating external compression of trachea. The child was further evaluated and managed for dissecting aneurysm of the aorta. Discussion: Among the various causes for stridor in pediatric-trauma population, dissecting aortic aneurysm is a rare cause. The association of elevated renal parameters to dissecting aortic aneurysm has been documented in various studies. Wheezing, shortness of breath, and stridor indicate a tracheal obstruction in a patient with aortic aneurysm. Computed tomography angiography is the investigation of choice. The defect needs to be repaired by a vascular graft under cardiopulmonary bypass. Conclusion: Stridor in pediatric population with etiology as dissecting aneurysm is unusual. A rare presentation like this deserves to be kept in mind while evaluating stridor in pediatric trauma patients by an emergency physician.