The three types of right aortic arch
01 May 1970-American Journal of Roentgenology (Am J Roentgenol Radium Ther Nucl Med)-Vol. 109, Iss: 1, pp 67-74
TL;DR: Right aortic arch with mirrorimage branching of the major arteries and right arch with isolation of the left subclavian artery are frequently associated with cyanotic congenital heart disease.
Abstract: 1. Right aortic arch can be divided into 3 sub-groups according to the branching of the arch vessels.2. Right aortic arch and an aberrant left subclavian artery is the most common type of right arch and can be identified by the large posterior defect on the barium-filled esophagus. Right aortic arch with mirrorimage branching of the major arteries and right arch with isolation of the left subclavian artery are frequently associated with cyanotic congenital heart disease. The lateral esophagogram in these types is usually normal.3. The embryologic, anatomic and roentgenologic features of each of these types are discussed.
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TL;DR: Practical aspects of certain common and uncommon congenital anomalies affecting the tracheobronchial tree, lung, and mediastinum, with emphasis on radiologic manifestations are analyzed and illustrated.
Abstract: Congenital anomalies of the chest are an important cause of morbidity in infants, children, and even adults. The evaluation of affected patients frequently requires multiple imaging modalities to d...
379 citations
TL;DR: US has become important in the evaluation of the pediatric gastrointestinal tract and is being used in an increasing number of applications and CT and magnetic resonance imaging are unsuitable for general screening but provide superb anatomic detail and added diagnostic specificity.
Abstract: A wide spectrum of congenital anomalies may affect the upper gastrointestinal tract, including anomalies of the esophagus (eg, atresia, fistulas, webs, duplications, vascular rings), stomach (eg, congenital gastric outlet obstruction, duplications), and duodenum (eg, atresia, annular pancreas, duplications, malrotation). The evaluation of affected patients can require multiple imaging modalities for diagnosis and surgical planning. Radiography is often diagnostic and specific and can usually provide important clues to help determine the optimal diagnostic procedure. Neonates with complete gastric or upper intestinal obstruction do not usually require further radiologic evaluation after radiography: Barium studies are usually contraindicated, and complementary procedures (eg, ultrasound [US], computed tomography [CT]) are not usually helpful and may even delay surgery, resulting in death. Nevertheless, US has become important in the evaluation of the pediatric gastrointestinal tract and is being used in an...
115 citations
TL;DR: Whereas anomalies of the central thoracic vasculature are uncommon, variants in the aortic arch branching pattern are common and an appreciation of the appearance of these entities on CT angiography allows for precise reporting and is useful in preprocedure planning.
Abstract: Objective: To determine the prevalence and clinical significance of normal, variant, and anomalous branching patterns of the aortic arch and the central veins on computed tomographic (CT) angiography in adults. Methods: We retrospectively reviewed 1000 consecutive CT angiograms of the chest in 658 women and 342 men with a median age of 53 years. Results: A total of 65.9% of patients had both normal aortic arch branching patterns and normal venous anatomy. Variants in the aortic arch branching pattern were present in 32.4% and anomalies in 1.5%. Venous anomalies were present in 0.7%. Review of CT reports showed that cardiothoracic radiologists correctly reported the anomaly more frequently than other radiologists (94% vs 20%, P = 0.003). Conclusions: Whereas anomalies of the central thoracic vasculature are uncommon, variants in the aortic arch branching pattern are common. An appreciation of the appearance of these entities on CT angiography allows for precise reporting and is useful in preprocedure planning.
107 citations
TL;DR: Bilateral ductus arteriosus was clinically recognized in 27 patients studied angiographically from 1963 through May 1983 and understanding the symmetric or paired nature of the primitive aortic arch system in the developing human heart facilitates recognition of the patterns of fourth and sixth arch anomalies seen with bilateral DA.
Abstract: Bilateral ductus arteriosus (DA) was clinically recognized in 27 patients studied angiographically from 1963 through May 1983. Distal bilateral DA origin of non-confluent pulmonary arteries was identified in 15 patients, ectopic or distal ductal origin of 1 pulmonary artery in 9 patients (5 without evidence of intracardiac disease) and isolation of the left subclavian artery in 3 (all 3 of whom had a right aortic arch). Other conditions reported to be associated with bilateral DA include interruption of the aortic arch with isolation of a subclavian artery, aortic atresia with interruption of the aortic arch in which bilateral DA supports the entire systemic circulation, bilateral DA complicating forms of congenitally malformed hearts other than those just stated, and, rarely, bilateral DA in isolation. Understanding the symmetric or paired nature of the primitive aortic arch system in the developing human heart facilitates recognition of the patterns of fourth and sixth arch anomalies seen with bilateral DA.
74 citations
TL;DR: These imaging modalities have added safety, speed, and superb resolution in diagnosis and, as in the case of MDCT, provide additional information about the airway and lung parenchyma, resulting in a more comprehensive examination with greater anatomic coverage.
58 citations
References
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Book•
01 Jan 1964
239 citations
TL;DR: The presence of associated congenital heart disease and even its type are usually predictable from the location of the imprint of the right arch on the barium-filled esophagus.
Abstract: Right aortic arch may occur as an isolated anomaly or in combination with congenital heart disease, its course under these two circumstances being generally quite different. With cyanotic heart disease, especially the tetralogy of Fallot and truncus arteriosus, the right arch is almost invariably the mirror image of the normal left arch and thus lies anterior and to the right of the trachea and the esophagus. On the other hand, when the right arch exists as an isolated anomaly, it extends posteriorly behind the esophagus. Thus, as will be shown, the presence of associated congenital heart disease and even its type are usually predictable from the location of the imprint of the right arch on the barium-filled esophagus. The two types of right aortic arch and their relationship to congenital heart disease have received little comment in the literature. Edwards (4) mentioned this correlation and Eisen (5) reported 8 patients with the posterior type of right arch, none of whom had congenital heart disease. Ar...
139 citations
TL;DR: Forty-one well-studied thoracic arterial arch anomalies are related to cases previously reported in the literature and presented with simplified drawings in an attempt to provide a workable understanding of these anomalies.
Abstract: Forty-one well-studied thoracic arterial arch anomalies are related to cases previously reported in the literature and presented with simplified drawings in an attempt to provide a workable understanding of these anomalies.
42 citations
TL;DR: Two patients with a right aortic arch and isolation of the left subclavian artery and retrograde vertebral flow with no features to suggest cerebrovascular insufficiency or congenital heart disease are presented.
Abstract: Two patients with a right aortic arch and isolation of the left subclavian artery are presented. The clinical findings resulted from relative ischemia of the left arm. There were no features to suggest cerebrovascular insufficiency or congenital heart disease. The esophagograms showed no posterior esophageal compression. In one patient the distal left subclavian artery was opacified by collateral channels from the left external carotid artery through the vertebal artery and branches of the thyrocervical and costocervical trunks. In the other, aortography demonstrated retrograde vertebral flow filling the distal left subclavian artery.
34 citations
TL;DR: Angiographic evidence of retrograde vertebrosubclavian flow in 2 children, both of which have identical congenital anomalies, is presented and it is suggested that in some adults with the “subClavian steal” the arterial stenosis is of congenital origin.
Abstract: Angiographic evidence of retrograde vertebrosubclavian flow in 2 children is presented. Both have identical congenital anomalies, namely, right aortic arch, aortic diverticulum, left subclavian atresia in one and severe stenosis of the same artery in the other. Although one of these children has what might be the onset of claudication in the arm, symptoms of cerebral ischemia, i.e., “subclavian steal” are absent. Additional blood flow to the affected arm from the cervical collateral vessels and the absence of cerebral atherosclerosis may be factors responsible for the absence of symptoms in these children. It is suggested that in some adults with the “subclavian steal” the arterial stenosis is of congenital origin. The importance of inequality of the radial pulses and blood pressures, a sign found in both adults and children, is emphasized. Clinical differentiation of the sign, also present in coarctation of the aorta with stenosis of the left subclavian artery and the supravalvular aortic stenosis syndrome, is discussed. The anomalies associated with a right aortic arch can be predicted from plain chest roentgenograms with barium swallow by noting the side (right or left) on which the arch and the first part of the aorta descend and the size and shape of the esophageal impressions in the posteroanterior and left anterior oblique views.
31 citations