Right Aortic Arch With Aberrant Left Subclavian Artery

  • Etiology: congenital, ligamentum arteriosum completes the ring
  • Imaging: right arch, aberrant left subclavian artery, may cause airway compression, has diverticulum of Kommerell which is bulbous configuration of portion of residual dorsal aorta at origin of an aberrant left subclavian artery, descending aorta usually right sided, left sided ligamentum arteriosum completes the ring extending between left pulmonary artery + diverticulum, ductus is opposite side of aortic arch + arises from junction between diverticulum and normal sized subclavian artery, if there is no diverticulum, ductus is on same side as aortic arch and there is no ring
  • UGI: posterior indentation on the esophagus
  • Clinical: second most common vascular ring, most common right arch, rarely associated with congenital heart disease

Radiology Cases of Right Aortic Arch With Aberrant Left Subclavian Artery

CXR of right aortic arch with aberrant left subclavian artery
CXR shows a right side aortic arch. Echocardiogram showed an aberrant left subclavian artery.

Surgery Cases of Right Aortic Arch With Aberrant Left Subclavian Artery

Surgical image through a thoracotomy incision (left) shows blue vessel loop around an aberrant left subclavian artery arising from a Kommerell diverticulum. Black suture loop is around a patent ductus arteriosus that was noted to extend from the Kommerell diverticulum and completed a vascular ring which was compressing the esophagus posterior to it. Surgical image (right) with the patent ductus arteriosus mobilized off the esophagus which is between the tips of the hemostat show the esophagus now resorting to its normal caliber.
Surgical image of right aortic arch with aberrant left subclavian artery
Surgical image taken through a left thoracotomy shows a blue vessel loop around the ligamentum arteriosum which was compressing the esophagus posterior to it. The red vessel loops are around the right aortic arch (on the right) and the left subclavian artery (on the left). The vascular ring was subsequently divided by division of the ligamentum arteriosum. The vascular ring then sprang open dramatically, relieving its compression upon the esophagus.