Journal of Clinical and Preventive Cardiology

IMAGE IN CARDIOLOGY
Year
: 2018  |  Volume : 7  |  Issue : 1  |  Page : 32--33

Image challenge


Vishnu Sharma Moleyar 
 Department of Respiratory Medicine, A J Institute of Medical Sciences, Mangaluru, Karnataka, India

Correspondence Address:
Dr. Vishnu Sharma Moleyar
Professor and Head, Department of Respiratory Medicine, A J Institute of Medical Sciences, Mangaluru - 575 004, Karnataka
India




How to cite this article:
Moleyar VS. Image challenge.J Clin Prev Cardiol 2018;7:32-33


How to cite this URL:
Moleyar VS. Image challenge. J Clin Prev Cardiol [serial online] 2018 [cited 2022 Oct 4 ];7:32-33
Available from: https://www.jcpconline.org/text.asp?2018/7/1/32/222925


Full Text

 QuestiIon:



What is the major abnormality seen in these images?

{Figure 1}{Figure 2}

For answer, please refer to the next page.

 Answer



Right sided aortic arch

This is a rare anatomical variant in which the aortic arch is on the right side instead of the left side. The prevalence of right-sided aortic arch in adults is about 0.01%. In people with a right-sided aortic arch, the right dorsal aorta persists and the distal left aorta disappears during embryonic development. Right-sided aortic arch can be mirror image of a normal left-sided arch, in which case, situs inversus may also be present. Alternatively, the right-sided arch may give rise to a left subclavian artery that passes leftward behind the esophagus or the arch may cross over into a normal left-sided descending thoracic aorta.[1] The mirror-image type of right aortic arch is associated with congenital heart disease, in most cases Tetralogy of Fallot (in about 20%). Truncus arteriosus may also be present in some cases.[1] Chromosome 22q11 deletions have been found in some patients.

A right-sided aortic arch does not cause symptoms by itself. When it is accompanied by other vascular abnormalities, it may form a vascular ring, causing symptoms due to compression of the trachea and/or esophagus.[2] Tracheal compression can lead to dyspnea and stridor in newborns and infants. In later life, tracheal compression can manifest with recurrent respiratory infections. Esophageal compression can lead to dysphagia.

During pregnancy, prenatal ultrasound may reveal the abnormal course of the arch in the fetus.[3] On chest radiography, a right-sided aortic arch is visualized by the aortic knob on the right side of sternum instead of the left side. Complex lesions associated with other cardiovascular anomalies are often best assessed by magnetic resonance imaging or computed tomography (CT) scan.[4]

This was a routine preoperative chest X-ray taken in a patient before surgery for inguinal hernia. He did not have any respiratory or cardiac symptoms. This patient had mirror image type right-sided aortic arch. CT scan thorax did not reveal any other abnormality.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil

Conflicts of interest

There are no conflicts of interest.

References

1Cinà CS, Arena GO, Bruin G, Clase CM. Kommerell's diverticulum and aneurysmal right-sided aortic arch: A case report and review of the literature. J Vasc Surg 2000;32:1208-14.
2Backer CL, Ilbawi MN, Idriss FS, DeLeon SY. Vascular anomalies causing tracheoesophageal compression. Review of experience in children. J Thorac Cardiovasc Surg 1989;97:725-31.
3Tuo G, Volpe P, Bava GL, Bondanza S, De Robertis V, Pongiglione G, et al. Prenatal diagnosis and outcome of isolated vascular rings. Am J Cardiol 2009;103:416-9.
4van Son JA, Julsrud PR, Hagler DJ, Sim EK, Puga FJ, Schaff HV, et al. Imaging strategies for vascular rings. Ann Thorac Surg 1994;57:604-10.