Korean J Radiol.  2013 Oct;14(5):845-848. 10.3348/kjr.2013.14.5.845.

Multi-Detector Row Computed Tomographic Evaluation of a Rare Type of Complete Vascular Ring: Double Aortic Arch with Atretic Left Arch Distal to the Origin of Left Subclavian Artery

• Hung YY
• Fu YC
• Wei HJ
• Tsai IC
• Chen CC

• KMID: 1711445
• DOI: http://doi.org/10.3348/kjr.2013.14.5.845

Abstract

Double aortic arch with an atretic left arch distal to the origin of left subclavian artery was diagnosed with multi-detector row computed tomography (MDCT) in two children with dysphagia. This rare type of complete vascular ring is clinically important because it may be confused with right aortic arch in mirror imaging. Anatomic details of this rare type of complete vascular ring demonstrated on MDCT facilitated appropriate surgical treatment.

Keyword

Computed tomography; Vascular ring; Double aortic arch

MeSH Terms

Adolescent
Aorta, Thoracic/*abnormalities/radiography/surgery
Child, Preschool
Deglutition Disorders/etiology/radiography/surgery
Female
Humans
Multidetector Computed Tomography/*methods
Subclavian Artery/*abnormalities/radiography/surgery
Vascular Malformations/complications/*radiography/surgery
Vascular Surgical Procedures

Figure

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  Fig. 1 Key medicl images of case 1. A. Double contrast esophagogram of Case 1. Left posterior oblique view of esophagus revealed posterior indentation over middle portion (arrow). Pre- and post-operational multi-detector row computed tomography images of Case 1. B. Posterior volume rendering image shows proximity of posterioinferiorly distorted LSCA (arrowhead), descending aortic diverticulum (dashed arrow), and pulmonary artery pouch (arrow) before surgery. C. Posterior volume rendering image one year after division and oversewing. Upward migration of LSCA (arrowhead) and separation of descending aorta diverticulum (dashed arrow) and pulmonary artery pouch (arrow) are shown. LSCA = left subclavian artery

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  Fig. 2 Multi-detector row computed tomography image of Case 2. Posterior volume rendering image. Proximity of posteroinferiorly distorted left subclavian artery (arrowhead), descending aortic diverticulum (dashed arrow) and pulmonary artery pouch (arrow) suggests fibrous connection (*) among these structures, and demonstrates double aortic arch with atretic left aortic arch distal to origin of left subclavian artery.

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  Fig. 3 Schematic figure of vascular ring. A. Double aortic arch is one of most common causes of vascular ring. B. Right aortic arch with aberrant left subclavian artery from diverticulum of Kommerell also results in vascular ring. C. Double aortic arch with atretic left aortic arch distal to origin of left subclavian artery is rare type of vascular ring. D. Right aortic arch with mirror image branching does not comprise vascular ring, but mimics vascular ring type of double aortic arch with atretic left aortic arch distal to origin of left subclavian artery (C).

Reference

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