Right Aortic Arch
Chest radiograph shows right paratracheal density with leftward tracheal deviation.
Right Aortic Arch
It is due to partial regression of left fourth aortic arch.
At least five different types. Only two of importance
a.Mirror-image type almost always has associated CHD, usuallyTOF
b.Aberrant Left Subclavian type rarely has associated CHD. Most common type.
Imaging Findings
Radiography
- Right paratracheal density
- Absence of normal left aortic arch
- Leftward tracheal deviation
- Retroesophageal density on lateral view common in adults
- Leftward displacement of barium column on esophagram
CT Findings
- CTA
- Right aortic arch with aberrant left subclavian artery
- Arch passes to right of trachea
- Four branches: Left carotid, right carotid, right subclavian, left subclavian arteries
- Retroesophageal vessel
- Dilated subclavian artery (diverticulum of Kommerell) may cause esophageal compression
- Aortic arch usually descends on right
- Right aortic arch with mirror imaging branching
- Arch passes to right of trachea
- Three branch vessels: Left innominate, right carotid, right subclavian arteries
- No retroesophageal vessel
- Mirror imaging branching usually associated with congenital heart disease in children
- No tracheal or esophageal compression typically
- Ancillary findings: Stigmata of congenital heart disease
- Right aortic arch with aberrant left subclavian artery
Treatment
- None for anomalies unless symptomatic
- Surgery for relief of dysphagia or stridor
- Surgery for aneurysmal dilatation of diverticulum of Kommerell