CTICasesRight Aortic Arch with Aberrant Left Subclavian Artery and Separate Left Carotid Origins
Imaging findings
Contrast-enhanced CT reveals a right-sided aortic arch with an unusual branching pattern. The first branch is a diminutive vessel arising from the ascending aorta that runs adjacent to the left internal jugular vein (representing separate left internal/external carotid origins); the second branch is a larger right common carotid artery; and the third is a retroesophageal aberrant left subclavian artery that branches into a left vertebral artery and left subclavian artery.
Key takeaways
Right-sided aortic arches can present with complex and highly unusual branching variations. Separate origins of the left internal and external carotid arteries, combined with an aberrant left subclavian artery, represent an extremely rare congenital arch anomaly that can mimic cervical arches but may not reach as superiorly into the neck.
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