Right-sided aortic arch
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A rightRight sided aortic arch is a type of aortic arch variant.
Epidemiology
It is thought to occur in approximately ~0.1% (range 0.05-0.2%) of the population.
Pathology
Classification
The right sided arch can be divided into at least three types (please note that the numbering of the types varies from publication to publication and as such the abnormality should be described rather than merely numbered) 1,7,11-13.
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type I:
-right sided aortic arch with mirror image branching- sometimes reported as the most common, accounting for up to 59% of all right sided arches11. In most of the literature it is less common than type II1
. - occurs from interruption of the dorsal segment of the left arch between the left subclavian artery and the descending aorta, with regression of the right ductus arteriosus in the hypothetical double aortic arch
- usually associated with cyanotic congenital heart disease which include
- sometimes reported as the most common, accounting for up to 59% of all right sided arches11. In most of the literature it is less common than type II1
-
type II:
-right sided aortic arch with aberrant left subclavian artery- common 1
. at, at least accounting for 39.5% of all right sided arches 11 - associated with Kommerell's diverticulum 11
- occurs from interruption of the dorsal segment of the left arch between the left common carotid and left subclavian arteries with regression of the right ductus arteriosus in the hypothetical double aortic arch
- rarely produces symptoms and is usually incidental although can rarely cause oesophageal and/or tracheal compression 10
. - rarely associated with other cardiovascular abnormalities
- common 1
-
type III:
-right sided aortic arch with isolation of the left subclavian artery 1,6- most rare type: 0.8% 11
- results from interruption of the left arch at two levels, with one level between the left common carotid and left subclavian arteries and the other level distal to the attachment of the left ductus
- may be associated with congenital subclavian steal syndrome and vertebrobasilar insufficiency
- can be rarely associated with congenital heart disease
Radiographic features
Plain film - chestChest radiograph
- left aortic contour is absent
. - tracheal bowing to the left at the the level of the right aortic arch
. - soft tissue indentation on right side of the distal trachea
. - right sided descending aorta
.
The right arch is often seen as high riding and projecting as a mass in the right para-tracheal region 4.
Cross sectional imaging - CT: CT/ MRI
Will allow direct visualisation of arch anatomy although the exact configuration with depend on the type.
-<p>A <strong>right sided aortic arch</strong> is a type of <a href="/articles/variant-anatomy-of-the-aortic-arch">aortic arch variant</a>.</p><h4>Epidemiology</h4><p>It is thought to occur in approximately ~0.1% (range 0.05-0.2%) of the population.</p><h4>Pathology</h4><h5>Classification</h5><p>The right sided arch can be divided into at least three types (please note that the numbering of the types varies from publication to publication and as such the abnormality should be described rather than merely numbered) <sup>1,7,11-13</sup>.</p><ul>- +<p><strong>Right sided aortic arch</strong> is a type of <a href="/articles/variant-anatomy-of-the-aortic-arch">aortic arch variant</a>.</p><h4>Epidemiology</h4><p>It is thought to occur in approximately ~0.1% (range 0.05-0.2%) of the population.</p><h4>Pathology</h4><h5>Classification</h5><p>The right sided arch can be divided into at least three types (please note that the numbering of the types varies from publication to publication and as such the abnormality should be described rather than merely numbered) <sup>1,7,11-13</sup>.</p><ul>
-<strong>type I </strong>- <strong>right sided aortic arch with mirror image branching</strong><ul>-<li>sometimes reported as the most common, accounting for up to 59% of all right sided arches<sup>11</sup>. In most of the literature it is less common than type II<sup>1.</sup>- +<strong>type I:</strong> <strong>right sided aortic arch with mirror image branching</strong><ul>
- +<li>sometimes reported as the most common, accounting for up to 59% of all right sided arches <sup>11</sup>. In most of the literature it is less common than type II <sup>1</sup>
-<strong>type II</strong> - <strong>right sided aortic arch with aberrant left subclavian artery</strong><ul>-<li>common <sup>1</sup>. at least accounting for 39.5% of all right sided arches <sup>11 </sup>- +<strong>type II:</strong> <strong>right sided aortic arch with aberrant left subclavian artery</strong><ul>
- +<li>common <sup>1</sup>, at least accounting for 39.5% of all right sided arches <sup>11 </sup>
-<li>rarely produces symptoms and is usually incidental although can rarely cause oesophageal and/or tracheal compression <sup>10</sup>.</li>- +<li>rarely produces symptoms and is usually incidental although can rarely cause oesophageal and/or tracheal compression <sup>10</sup>
- +</li>
-<strong>type III </strong>- <strong>right sided aortic arch with isolation of the left subclavian artery</strong> <sup>1,6</sup><ul>- +<strong>type III:</strong> <strong>right sided aortic arch with isolation of the left subclavian artery</strong> <sup>1,6</sup><ul>
-</ul><h4>Radiographic features</h4><h5>Plain film - chest radiograph</h5><ul>-<li>left aortic contour is absent. </li>-<li>tracheal bowing to the left at the the level of the right aortic arch. </li>-<li>soft tissue indentation on right side of the distal trachea.</li>-<li>right sided descending aorta.</li>-</ul><p>The right arch is often seen as high riding and projecting as a mass in the right para-tracheal region <sup>4</sup>.</p><h5>Cross sectional imaging - CT/ MRI</h5><p>Will allow direct visualisation of arch anatomy although the exact configuration with depend on the type.</p>- +</ul><h4>Radiographic features</h4><h5>Chest radiograph</h5><ul>
- +<li>left aortic contour is absent</li>
- +<li>tracheal bowing to the left at the the level of the right aortic arch</li>
- +<li>soft tissue indentation on right side of the distal trachea</li>
- +<li>right sided descending aorta</li>
- +</ul><p>The right arch is often seen as high riding and projecting as a mass in the right para-tracheal region <sup>4</sup>.</p><h5>Cross sectional imaging: CT/ MRI</h5><p>Will allow direct visualisation of arch anatomy although the exact configuration with depend on the type.</p>
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