Right sided aortic arch with anomalous left subclavian artery

Case contributed by Dr Jeremy Jones

Presentation

Difficulty swallowing on occasion. Recurrent cough.

Patient Data

Age: 6 years
Gender: Male

The lungs are clear. There is fullness of the right paratracheal stripe at the level of the carina.

The lateral series from the upper GI contrast study demonstrates a large posterior indentation of the esophagus.  The AP view shows that is an oblique indentation from lower right to upper left.

Post-contrast imaging confirms the presence of a right-sided aortic arch.  The posterior indentation of the esophagus is caused by the anomalous left subclavian artery that arises distal to the other two aortic branch vessels.

Case Discussion

The chest radiograph confirms the right-sided aortic arch. On the upper GI contrast study, there is posterior indentation of the esophagus which should not occur in a simple right-sided aortic arch. 

The posterior indentation is caused by an anomalous left subclavian artery that arises distal to the other aortic branch-vessels and passes posterior to the esophagus. This is confirmed on cross-sectional imaging.

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