J Cardiovasc Ultrasound.  2011 Sep;19(3):163-166. 10.4250/jcu.2011.19.3.163.

A Case of Balanced Type Double Aortic Arch Diagnosed Incidentally by Transthoracic Echocardiography in an Asymptomatic Adult Patient

Affiliations
  • 1Department of Internal Medicine, National Police Hospital, Seoul, Korea. bemasc@nph.go.kr

Abstract

A 36-year-old male patient with no remarkable medical history was admitted to our hospital for a health check up. On chest radiography, bilateral aortic notches at the level of aortic arch were shown suggesting aortic arch anomaly without any clinical symptoms. Two aortic arches were almost same-in-size on suprasternal view of transthoracic echocardiography. In addition, multidetector computed tomography showed balanced type double aortic arch forming a complete vascular ring which encircled the trachea and esophagus. The trachea was slightly compressed by the vascular ring whereas the esophagus was intact. Nevertheless, the pulmonary function test was normal. The patient was discharged from hospital with instructions for periodic follow-up.

Keyword

Double aortic arch; Echocardiography; Vascular ring

MeSH Terms

Adult
Aorta, Thoracic
Echocardiography
Esophagus
Follow-Up Studies
Humans
Male
Multidetector Computed Tomography
Respiratory Function Tests
Thorax
Trachea

Figure

  • Fig. 1 Chest radiography showed bilateral aortic notches at the level of aortic arch, suggesting aortic arch anomaly. Right aortic arch (large arrow) and left aortic arch (small arrow) can be seen.

  • Fig. 2 Transthoracic echocardiography showed double aortic arch. Descending aorta which is located in the middle can be seen posterior to left atrium on parasternal short axis view (arrow) (A). Right aortic arch (left arrow) and left aortic arch (right arrow) (B) can be found together and respectively, right aortic arch (C), left aortic arch (D) and their branches on suprasternal view. RAA: right aortic arch, RCCA: right common carotid artery, RSCA: right subclavian artery, LAA: left aortic arch, LCCA: left common carotid artery, LSCA: left subclavian artery.

  • Fig. 3 Chest computed tomography showed double aortic arch. Right aortic arch (A) and left aortic arch (B) can be seen and both aortic arches fuse into descending aorta located in front of the spine (C).

  • Fig. 4 Reconstructed images of chest computed tomography showed balanced type double aortic arch (A) with only slight compression of the trachea (B).


Reference

1. Yilmaz M, Tok M, Cengiz M. Asymptomatic balanced-type double aortic arch in an elderly patient: a case report. Heart Surg Forum. 2007. 10:E297–E298.
Article
2. Ito H, Konishi A, Kon-Nai T, Ishibashi T, Takahashi S. Double aortic arch with atresia, tapering and aneurysm of the left arch. Br J Radiol. 2006. 79:e71–e74.
Article
3. Ikenouchi H, Tabei F, Itoh N, Nozaki A. Images in cardiovascular medicine. Silent double aortic arch found in an elderly man. Circulation. 2006. 114:e360–e361.
4. Sariaydin M, Findik S, Atici AG, Ozkaya S, Uluisik A. Asymptomatic double aortic arch. Int Med Case Rep J. 2010. 3:63–66.
5. Stewart JR, Kincaid OW, Edwards JE. An atlas of vascular rings and related malformations of the aortic arch system. 1963. Springfield: Thomas;579–580.
6. Jeeyani HN, Prajapati VJ, Patel NH, Shah SB. Imaging features of double aortic arch shown by multidetector computed tomography angiography. Ann Pediatr Cardiol. 2010. 3:169–170.
Article
7. Lowe GM, Donaldson JS, Backer CL. Vascular rings: 10-year review of imaging. Radiographics. 1991. 11:637–646.
Article
8. Schlesinger AE, Krishnamurthy R, Sena LM, Guillerman RP, Chung T, DiBardino DJ, Fraser CD Jr. Incomplete double aortic arch with atresia of the distal left arch: distinctive imaging appearance. AJR Am J Roentgenol. 2005. 184:1634–1639.
Article
9. Kellenberger CJ. Aortic arch malformations. Pediatr Radiol. 2010. 40:876–884.
Article
10. Jaffe RB. Radiographic manifestations of congenital anomalies of the aortic arch. Radiol Clin North Am. 1991. 29:319–334.
11. Moes CA, Freedom RM. Rare types of aortic arch anomalies. Pediatr Cardiol. 1993. 14:93–101.
Article
12. Baraldi R, Sala S, Bighi S, Mannella P. Vascular ring due to double aortic arch: a rare cause of dysphagia. Eur J Radiol Extra. 2004. 52:21–24.
Article
13. Emmel M, Schmidt B, Schickendantz S. Double aortic arch in a patient with Fallot's tetralogy. Cardiol Young. 2005. 15:52–53.
Article
14. Kim HY, Jung HY, Yun TJ, Lee SS, Lee EY, Ko KH, Kim YM, Myung SJ, Yang SK, Hong WS, Kim JH, Min YI. Three cases of dysphagia due to vascular ring in adults. Korean J Gastrointest Endosc. 2000. 21:735–740.
15. Lee ML. Diagnosis of the double aortic arch and its differentiation from the conotruncal malformations. Yonsei Med J. 2007. 48:818–826.
Article
16. Koz C, Yokusoglu M, Uzun M, Tasar M. Double aortic arch suspected upon transthoracic echocardiography and diagnosed upon computed tomography. Tex Heart Inst J. 2008. 35:80–81.
17. Lotz J, Macchiarini P. Images in clinical medicine. Double aortic arch diagnosed by magnetic resonance imaging. N Engl J Med. 2004. 351:e20.
18. van Son JA, Julsrud PR, Hagler DJ, Sim EK, Puga FJ, Schaff HV, Danielson GK. Imaging strategies for vascular rings. Ann Thorac Surg. 1994. 57:604–610.
Article
19. Lillehei CW, Colan S. Echocardiography in the preoperative evaluation of vascular rings. J Pediatr Surg. 1992. 27:1118–1120. discussion 1120-1.
Article
20. Kypson AP, Anderson CA, Rodriguez E, Koutlas TC. Double aortic arch in an adult undergoing coronary bypass surgery: a therapeutic dilemma? Eur J Cardiothorac Surg. 2008. 34:920–921.
Article
21. Alsenaidi K, Gurofsky R, Karamlou T, Williams WG, McCrindle BW. Management and outcomes of double aortic arch in 81 patients. Pediatrics. 2006. 118:e1336–e1341.
Article
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