IS Case 226: Aberrant right subclavian artery with left-sided arch

Scott Mooney, MD


Imaging Sciences URMC 2008
Publication Date: 2009-05-22

History

Patient is a 27-year-old female who presented to the emergency department with sharp chest pain radiating to the back. CT was performed for clinical suspicion of pulmonary embolism.

Findings

The right subclavian artery arises as the last branch off of the aortic arch, and passes posterior to the esophagus and trachea. No pulmonary embolism was seen.

Diagnosis

Aberrant right subclavian artery with left-sided arch

Discussion

The aberrant right subclavian artery (ARSA) is the most common anomaly of the aortic arch (when a bovine arch and different vertebral arteries origins are considered normal variants), with an incidence reported of 0.5-2%. The ARSA arises as the most distal major branch of the aortic arch, and almost always passes posterior to the esophagus and trachea. Usually this is an incidental finding, with dysphagia an uncommon presenting symptom. Dilatation of the origin of an ARSA is termed a diverticulum of Kommerrell. On an upper gastrointestinal study, it manifests as a smooth, posterior indentation on the esophagus.

References

  1. Freed K, Low VH. The aberrant subclavian artery. AJR Am J Roentgenol. 1997 Feb;168(2):481-4. [PMID: 9016231]
  2. Ka-Tak W, Lam WW, Yu SC. MDCT of an aberrant right subclavian artery and of bilateral vertebral arteries with anomalous origins. AJR Am J Roentgenol. 2007 Mar;188(3):W274-5. [PMID: 17312035]

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