Vascular ring presenting as failure to thrive

A 6-month-old female presented with persistent post-prandial vomiting and poor weight gain despite adequate caloric intake. Physical examination revealed an emaciated but otherwise stable infant. Laboratory findings were normal. A barium esophagogram demonstrated posterior esophageal indentation suggestive of extrinsic compression, and computed tomography angiography revealed a right-sided aortic arch with retroesophageal Kommerell diverticulum and aberrant left subclavian artery – completing a vascular ring. Surgical division of the ligamentum arteriosum led to rapid symptom resolution and catch-up growth. This case underscores the importance of considering vascular rings in infants with unexplained feeding difficulties or failure to thrive, even in the absence of respiratory symptoms. Keywords: Vascular ring, Kommerell diverticulum, Failure to thrive