Presentation
An anatomic variant found on CT of a patient who complained of generalized epigastric/abdominal pain
Patient Data
Bovine trunk; the brachiocephalic artery and the left common carotid artery share a common origin of the aortic arch. The left subclavian artery has a normal origin.
There is a left retroperitoneal mass which encases the left kidney. It is in keeping with a high-grade lymphoma. It extends into the suprarenal fossa with obscuration of the left adrenal gland. In addition, it encases the left kidney and proximal ureter with sparing of the left inferior pole.
Multiple enlarged lymph nodes can also be seen in bilateral retrocrural and pre-aortic locations.
Non-obstructive cholelithiasis is present. Bilateral renal cysts. Mild splenomegaly.
Case Discussion
The bovine aortic arch describes the most common variant of the aortic arch in humans. It is found in an estimated 27% of the population with various subtypes 1. Our patient has the more common B subtype (common origin point of the brachiocephalic artery and left common carotid artery), as opposed to the less common A and C (true bovine arch) subtypes.
The retroperitoneal mass is the most likely cause of the patient's epigastric pain. Subsequent tissue sampling of the mass revealed large B-cell lymphoma.
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