CTICasesFive-Vessel Aortic Arch
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Imaging findings
Contrast-enhanced CT chest shows a five-vessel aortic arch. Branching order from proximal to distal consists of the right common carotid, left common carotid, left subclavian, an aberrant right subclavian, and a fifth vessel arising from the distal arch/proximal descending aorta that courses retroesophageally to become an aberrant right vertebral artery.
Key takeaways
A five-vessel aortic arch is an exceedingly rare congenital vascular variant. It typically occurs when an aberrant right vertebral artery arises directly from the distal arch or descending aorta, rather than its normal origin from the right subclavian artery. While usually asymptomatic, recognizing this anatomy is essential for planning spinal, thoracic, or endovascular interventions.
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