Double Aortic Arch

A scout CT image of a 70-year-old woman shows subtle prominence of the right paratracheal soft tissue. There is slight narrowing the trachea at the level of the left aortic arch. The patient also has a large hiatal hernia.

Coronal reformatted CT image shows a double aortic arch, in which the right-sided arch is approximately about the same size as the left.

Facts: Double Aortic Arch

• Most common symptomatic vascular ring
• Ascending aorta divides anterior to the trachea into left and right arches; right arch typically is larger and more superiorly located than the left arch and passes posterior to the esophagus joining the descending aorta
• Complete ring around trachea and esophagus may cause compression
• Usually not associated with congenital heart disease (if it is, tetralogy of Fallot predominates)
• Rarely presents in adulthood (as in our case)

Imaging

• Diagnosis often suggests by the presence of right sided aortic arch on radiography
• Barium esophagography shows bilateral indentations of the esophagus in AP view
• CT and MRI confirms the diagnosis. The size of each arch, degree of atresia (if present), branching patterns and degree of compression should be reported.

References:

1. McMillan JA, et al. Oski's pediatrics: principles & practice, 4th ed, 2006.

2. Moss AJ, et al. Moss and Adam's heart disease in infants, children, and adolescents, 7th ed, 2007.