CTICasesDouble Aortic Arch
Imaging findings
Frontal chest radiograph in an asymptomatic 79-year-old patient shows a right-sided aortic arch and retrotracheal soft-tissue fullness. Lateral radiograph demonstrates retrotracheal vascular compression. Contrast-enhanced chest CT confirms a double aortic arch forming a complete vascular ring, with a dominant right arch, a smaller left arch, and a right-sided descending thoracic aorta, causing narrowing and compression of the trachea.
Key takeaways
Double aortic arch is the most common congenital vascular anomaly that forms a complete vascular ring, resulting from the persistence of both the right and left embryonic fourth branchial arches. The ring encircles and compresses both the trachea and esophagus. While it typically presents in infancy with stridor or dysphagia, some individuals can remain completely asymptomatic into late adulthood until age-related vessel ectasia or atherosclerosis causes progressive airway compression.
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