right-sided aortic arch
Right-sided
aortic arch with aberrant left subclavian artery. Absent left aortic contour, presence of right aortic knob (red arrow), both hemidiaphragms are flat and low in position.
Normvariante
eines Arcus aortae dexter im seitlichen Röntgenbild des Thorax.
Toddler with
stridorCXR shows a right side aortic arch. Echocardiogram showed an aberrant left subclavian artery.The diagnosis was right aortic arch with aberrant left subclavian artery.
Right-sided
aortic arch with aberrant left subclavian artery. Right aortic arch (white arrow), distal tracheal deviation to the left (yellow arrow).
Right-sided
aortic arch with aberrant left subclavian artery. The descending aorta (D)continues inferiorly on the right side of the vertebral column.
Right-sided
aortic arch with aberrant left subclavian artery. Lateral view, slight rotation: 1. left CCA 2. right CCA 3. right subclavian artery 4. left subclavian artery (last branch) 5. Kommerell’s diverticulum 6. right-sided aortic arch 7. descending aorta
A diagnostic
approach to the mediastinal masses. a Contrast-enhanced CT scan shows a right-sided aortic arch (arrow) in an asymptomatic man with an absence of the aortic knuckle on the left. b Contrast-enhanced CT scan demonstrates a soft tissue posterior mediastinal mass (*) in a 66-year-old woman with multiple myeloma diagnosis. Note the mass effect to the descending aorta and left auricula by the mass and the bilateral pleural effusion (open arrows)
Computed
tomography in the evaluation of vascular rings and slings. Right aortic arch with Kommerell’s diverticulum. a Illustration of a right aortic arch (black arrow) with a prominent Kommerell diverticulum (white arrow) in the proximal descending thoracic aorta (*), compressing the oesophagus (E). b Axial CT scan shows a right aortic arch (arrow) with a large Kommerell diverticulum (arrowhead) compressing the posterior oesophagus. c Coronal MIP image demonstrates a right aortic arch (arrow) and prominent Kommerell diverticulum (arrowhead) in the proximal descending thoracic aorta (*). d Reconstructed 3D volume-rendered image exquisitely demonstrates the right aortic arch (arrow) with a large Kommerell diverticulum (*) giving off the retroesophageal aberrant left subclavian artery (arrowhead). e Coronal CT image shows airway narrowing (arrow) caused by the vascular ring
Computed
tomography in the evaluation of vascular rings and slings. Right arch with mirror image branching and a left ductus arteriosus. a Schematic illustration of a right aortic arch with mirror image branching shows a left brachiocephalic artery giving a branch to the left common carotid and left subclavian arteries. b Coronal MIP image and c Volume-rendered 3D image in a patient with a right aortic arch (A) and mirror image branching pattern show a patent ductus arteriosus (white arrow) extending from the left brachiocephalic (L BC) artery to the left pulmonary artery (L PA) forming a ring
Computed
tomography in the evaluation of vascular rings and slings. Circumflex right aortic arch. a Axial CT image shows a right aortic arch (arrow), which extends behind the oesophagus to reach the side. b Axial CT image at a lower level shows the arch has now reached the right (arrow) and continues as the descending aorta on the left. c Axial CT image at a lower level shows the left descending thoracic aorta (arrow)
Teenager with
dysphagia. Coronal CT with contrast of the chest (below) shows a right aortic arch with mirror image branching of the great vessels arising from it. Axial CT (above) shows a functional vascular ring with the trachea and esophagus going through the center of it.The diagnosis was right aortic arch without an aberrant vessel.
Right-sided aortic arch is a type of aortic arch variant characterized by the aortic arch coursing to the right of the trachea. Different configurations can be found based on the supra-aortic branching patterns, with the two most common patterns being the right-sided aortic arch with mirror image branching and the right-sided aortic arch with aberrant left subclavian artery (ALSA).
Epidemiology
A right-sided aortic arch is thought to occur in approximately ~0.1% (range 0.05-0.2%) of the population.
Clinical presentation
The majority of the patients are asymptomatic and it is discovered incidentally. However, it causes symptoms when associated with other vascular anomalies (vascular ring) due to compression on the esophagus and/or trachea.
Pathology
Classification
Right-sided arches can be divided into at least three types (please note that the numbering of the types varies from publication to publication and as such the abnormality should be described rather than merely numbered) .
- type I: right-sided aortic arch with mirror image branching
- sometimes reported as the most common, accounting for up to 59% of all right-sided arches . In most of the literature, it is less common than type II
- occurs from interruption of the dorsal segment of the left arch between the left subclavian artery and the descending aorta, with regression of the right ductus arteriosus in the hypothetical double aortic arch
- in this variant, the left brachiocephalic trunk arises first, followed by the right common carotid and right subclavian arteries
- usually associated with cyanotic congenital heart disease which includes
- type II: right-sided aortic arch with aberrant left subclavian artery
- common , at least accounting for 39.5% of all right-sided arches
- associated with a Kommerell diverticulum
- occurs from interruption of the dorsal segment of the left arch between the left common carotid and left subclavian arteries with regression of the right ductus arteriosus in the hypothetical double aortic arch
- in this variant, the left common carotid artery arises first, followed by the right common carotid, right subclavian, and then left subclavian arteries
- rarely produces symptoms and is usually incidental although can rarely cause esophageal and/or tracheal compression
- rarely associated with other cardiovascular abnormalities
- type III: right-sided aortic arch with isolation of the left subclavian artery
- most rare type: 0.8%
- results from interruption of the left arch at two levels, with one level between the left common carotid and left subclavian arteries and the other level distal to the attachment of the left ductus
- maybe associated with congenital subclavian steal syndrome and vertebrobasilar insufficiency
- can be rarely associated with congenital heart disease
Radiographic features
Plain radiograph
- left aortic contour is absent
- tracheal bowing to the left at the level of the right aortic arch
- soft tissue indentation on the right side of the distal trachea
- right-sided descending aorta
The right arch is often seen as high riding and projecting as a mass in the right paratracheal region .
CT/MRI
Cross-sectional imaging with CT or MRI allows direct visualization of arch anatomy and with dedicated angiographic techniques (MRA or CTA) excellent demonstration of the lumen can be achieved.
Siehe auch:
- Anomalien des Aortenbogens
- Herzfehler
- Fallot'sche Tetralogie
- Transposition der großen Arterien
- tricuspid atresia
- Subclavian-Steal-Syndrom
- Zyanotischer Herzfehler
- Truncus arteriosus communis
und weiter:
- Situs inversus
- congenital tracheo-oesophageal fistula
- CXR approach to congenital heart disease
- double outlet right ventricle (DORV)
- chest x-ray appeoach to congenital heart disease
- congenital heart disease - chest x-ray approach
- esophageal atresia with H-type tracheo-esophageal fistula
- Kommerell-Divertikel
- aberrierende linke Arteria subclavia
- H-type tracheo-oesophageal fistula with no atresia
- rechts descendierende Aorta mit aberrierender linker Arteria subclavia
- right aortic arch and agenesia of left pulmonary artery
- zirkumflexer retroösophagealer rechter Aortenbogen
- right sided aortic arch - fetal ultrasound
- vaskuläre Ringe
Assoziationen und Differentialdiagnosen zu rechts descendierende Aorta: 
