The ascending aorta is the first part of the aorta, and begins at the aortic valve - located obliquely just to the left of the midline at the level of the the third intercostal space. It terminates as it exits the fibrous pericarium and reaches the sternomanubrial joint, where it becomes the arch of aorta.
It normally has only two branches, the right coronary artery and the left coronary artery. These arise from the right and left aortic sinuses (of Valsalva) respectively, which are out-pouchings of the aortic wall above each cusp of the aortic valve. Immediately above the three aortic sinuses, the normal tubular configuration of the aorta is attained - at the sinotubular junction.
The ascending aorta ascends slightly towards the right of midline where it can be seen as part of the mediastinal outline on a CXR. This should only be the case in the older ectatic or dilated artery. In a young patient, a prominent ascending aorta, especially when combined with signs of left ventricular hypertrophy should raise suspicion of aortic stenosis.
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