OBJECTIVE: The purpose of this study was to review the imaging findings of children referred for cross-sectional imaging to evaluate persistent airway symptoms after surgical therapy for double aortic arch. CONCLUSION: Airway narrowing is clearly shown on cross-sectional imaging in patients with persistent airway symptoms after surgical therapy for double aortic arch. Two patterns of airway compression are typically seen: narrowing of the trachea at the level of the postsurgical arch and narrowing of the left main bronchus as a result of compression from a midline descending aorta. Both patterns may be seen in patients regardless of whether the left or the right arch has been ligated.