Right sided aortic arch with aberrant origin of left subclavian artery

Case contributed by Dr. Mandakini Siwach


Chronic cough and hoarseness with breathlessness.

Patient Data

Age: 63
Gender: Female

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:

  • The left vertebral artery is originating  from the left common carotid instead of subclavian artery.
  • The 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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Case information

rID: 53575
Published: 24th May 2017
Last edited: 16th Jul 2018
System: Vascular
Inclusion in quiz mode: Included

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