CTICasesDouble Aortic Arch with Atretic Segment Reclassified from Presumed Aberrant Subclavian
Imaging findings
In a patient originally classified elsewhere as having a right aortic arch with aberrant left subclavian artery, CT and coronal reformats show symmetric brachiocephalic vessels in the neck and a high right-sided aortic arch, with the left-sided (anterior) vascular moiety arising horizontally from the side of the arch rather than from its superior surface, giving rise to the left carotid and then, after an atretic segment beyond the subclavian origin, connecting to a left ligamentum arteriosum remnant marked by a focus of calcification.
Key takeaways
A horizontally coursing left-sided vascular moiety arising from the side (rather than the top) of a disproportionately high right aortic arch is a distinctive sign of double aortic arch with an atretic left arch segment, rather than the more commonly presumed right aortic arch with aberrant left subclavian artery -- with a genuinely aberrant subclavian, the right arch is not typically as high as it is with double arch physiology.
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