Double aortic arch

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Double aortic arch (DAA) is the most common symptomatic type of the aortic arch variant.

Clinical presentation

DAA is mostly diagnosed in childhood due to of symptoms related to oesophageal and/or tracheal obstruction. Respiratory symptoms can be more common in infancy or early childhood while adult patients complain of difficulties in swallowing rather than respiratory difficulties due to tracheal development.

Pathology

DAA is formed by formation of a vascular ring from the splitting of the ascending aorta into two limbs that pass to either side of the trachea and oesophagus ⁵ (both of which gets encircled), which then joins as a single descending aorta.

Sub types

right dominant arch: ~75%
co-dominant arch: ~5%
left dominant arch: ~25%

Radiographic features

CXR

Right sided aortic arch indenting the trachea and increase right paratracheal soft tissue thickness. Lack of air column in thoracic portion of the trachea sometimes seen.

Barium swallow

Contrast swallow studies are more helpful and demonstrates classic reverse S indentation of the contrast column on frontal view as well as posterior indentation on lateral view.

CT and MRI

Contrast enhanced cross sectional imaging is required to confirm the diagnosis and also to delineate details of anatomy in particular right or left arch dominance for surgical planning.

Treatment and prognosis

Surgical intervention with division of the minor (smaller) arch and ligamentum arteriosum is indicated for symptomatic patients.

-<p><strong>Double aortic arch (DAA)</strong> is type of <a href="/articles/variant-anatomy-of-the-aortic-arch">aortic arch variant</a>. </p><h4>Clinical presentation</h4><p>DAA is mostly diagnosed in childhood due to of symptoms related to oesophageal and/or tracheal obstruction. Respiratory symptoms can be more common in infancy or early childhood while adult patients complain of difficulties in swallowing rather than respiratory difficulties due to tracheal development.</p><h4>Pathology</h4><p>DAA is formed by formation of a vascular ring from the splitting of the <a href="/articles/ascending-aorta">ascending aorta</a> into two limbs that pass to either side of the <a href="/articles/trachea">trachea</a> and <a href="/articles/oesophagus">oesophagus</a> <sup>5</sup> (both of which gets encircled), which then joins as a single <a href="/articles/descending-aorta">descending aorta</a>. </p><h5>Sub types</h5><ul>
+<p><strong>Double aortic arch (DAA)</strong> is the most common symptomatic type of the <a href="/articles/variant-anatomy-of-the-aortic-arch">aortic arch variant</a>. </p><h4>Clinical presentation</h4><p>DAA is mostly diagnosed in childhood due to of symptoms related to oesophageal and/or tracheal obstruction. Respiratory symptoms can be more common in infancy or early childhood while adult patients complain of difficulties in swallowing rather than respiratory difficulties due to tracheal development.</p><h4>Pathology</h4><p>DAA is formed by formation of a vascular ring from the splitting of the <a href="/articles/ascending-aorta">ascending aorta</a> into two limbs that pass to either side of the <a href="/articles/trachea">trachea</a> and <a href="/articles/oesophagus">oesophagus</a> <sup>5</sup> (both of which gets encircled), which then joins as a single <a href="/articles/descending-aorta">descending aorta</a>. </p><h5>Sub types</h5><ul>
-</ul><h4>Treatment and prognosis</h4><p>Surgical intervention with division of the minor (smaller) arch and <a href="/articles/ligamentum-arteriosum">ligamentum arteriosum</a> is indicated for symptomatic patients.</p>
+</ul><h4>Radiographic features</h4><h6>CXR</h6><p>Right sided aortic arch indenting the trachea and increase right paratracheal soft tissue thickness. Lack of air column in thoracic portion of the trachea sometimes seen.</p><h6>Barium swallow</h6><p>Contrast swallow studies are more helpful and demonstrates classic reverse S indentation of the contrast column on frontal view as well as posterior indentation on lateral view. </p><h6>CT and MRI</h6><p>Contrast enhanced cross sectional imaging is required to confirm the diagnosis and also to delineate details of anatomy in particular right or left arch dominance for surgical planning.</p><h4>Treatment and prognosis</h4><p>Surgical intervention with division of the minor (smaller) arch and <a href="/articles/ligamentum-arteriosum">ligamentum arteriosum</a> is indicated for symptomatic patients.</p>

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