Right sided aortic arch with aberrant origin of left subclavian artery
Presentation
Chronic cough and hoarseness with breathlessness.
Patient Data
Right sided aortic arch is seen with an aberrant origin of the left subclavian artery, which is seen arising as a last branch from the arch. There is focal dilatation at its origin, consistent with a Kommerell's diverticulum.
Significant indentation and narrowing of the trachea is seen, which could probably be an explanation for patient's symptoms.
Additional vascular variations are noted:
- left vertebral artery is originating from the left common carotid instead of subclavian artery
- right vertebral artery is originating directly from the arch of aorta, in between the origins of right common carotid and right subclavian artery
Case Discussion
Right-sided aortic arch with aberrant origin of the left subclavian artery is an obstructing arch deformity as a complete ring is formed by ductus arteriosus between the left pulmonary artery and left subclavian artery.
Though often asymptomatically detected in adulthood, it can cause respiratory symptoms and difficulty swallowing in patients where the ring is too tight.
The usual sequence of origin of aortic arch branches is left common carotid, followed by right common carotid, right subclavian and finally the left subclavian artery. The left subclavian artery usually shows a focal dilatation at its origin, called as Kommerell's diverticulum.
The present case has additional variations in both vertebral arteries origin.
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