October 27, 2009

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)
  • 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.

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.

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