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British Journal of Radiology (2006) 79, e71-e74
© 2006 British Institute of Radiology
doi: 10.1259/bjr/28729845
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Double aortic arch with atresia, tapering and aneurysm of the left arch

H Ito, MD, PhD1, A Konishi, MD, PhD2, T Kon-Nai, MD, PhD2, T Ishibashi, MD, PhD3 and S Takahashi, MD, PhD3

Departments of 1Diagnostic Radiology and 2Cardiovascular Surgery, Miyagi Cardiovascular and Respiratory Center, Semine, Miyagi and 3Department of Diagnostic Radiology, Graduate School of Medicine, Tohoku University, Sendai, Japan


Figure 1
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  		Figure 1. Chest radiograph indicates an abnormal thoracic aortic arch with right-sided tracheal impression (large arrow). In addition, it demonstrates a small nodular shadow (small arrow) the left of the superior mediastinum.

 

Figure 2
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  		Figure 2. (a) Axial T1 weighted spin-echo image shows a "four artery sign", which comprises the anterior common carotid (large black arrows) and posterior subclavian (small black arrows) arteries in the symmetrical position. Moreover, the small left arch (small white arrow) transforms into an aneurysm (large white arrow) via the narrow lumen. (T, trachea; E, oesophagus). (b) Axial T1 weighted spin-echo image 2.5 cm inferior to (a) demonstrates proximal right aortic arch (RA) with a retro-oesophageal segment, anterior common carotid arteries (large black arrows), posterior right superior vena cava (large white arrow) and posteroinferior distal aortic arch (small black arrow). The proximal and middle aortic arch compresses the right lateral and posterior wall of the trachea (T) with resultant narrowing of the lumen. Displaced azygos vein (large white arrow), which separates the azygos lobe from right upper lobe, drains into the superior vena cava. Double white arrows show the position of the oesophagus.

 

Figure 3
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  		Figure 3. (a) Anteroposterior image of 3D volume-rendering MR angiography shows the right-sided aortic arch (RA), which divides the first two branches of the right common carotid (RC) and the right subclavian artery (RS). Then, the left subclavian (LS) and left common carotid arteries (LC) are derived from the third branch of the left innominate artery (arrow), which is eventually considered the small left arch (PA, pulmonary artery). (b) Deep left anterior oblique image of 3D volume-rendering MR angiography shows that the left subclavian (LS) and left common carotid artery (LC) are derived from the left arch (black arrow) locating proximal to the aneurysm (white arrow) (RC, right common carotid artery; RS, right subclavian artery; PA, pulmonary artery). (c) Deep right posterior oblique image of 3D volume-rendering MR angiography shows tapering and aneurysm (arrow) of the left arch (RA, right arch; PA, pulmonary artery; RC, right common carotid artery; RS, right subclavian artery; LC, left common carotid artery; LS, left subclavian artery).

 

Figure 4
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  		Figure 4. (a) The hypothetical double aortic arch system proposed by Edwards, showing zones of the left arch labelled A–D (RC, right common carotid artery; RS, right subclavian artery; LC, left common carotid artery; LS, left subclavian artery; AA, ascending aorta; PA, pulmonary artery; rda, right ductus arteriosus; lda, left ductus arteriosus). (b) Atresia of left arch (LAA) along the zone D in hypothetical double aortic arch demonstrates subtype 4 of the double aortic arch with left atretic arch. Moreover, tapering (Tap) and aneurysm (An) are probably located, respectively, in the A and B zones, but the correct origin of the left ductus arteriosus (lda) from the left arch is uncertain (RC, right common carotid artery; RS, right subclavian artery; LC, left common carotid artery; LS, left subclavian artery; AA, ascending aorta; PA, pulmonary artery; rda, right ductus arteriosus; lda, left ductus arteriosus). Illustrations are modified from those by B Singh et al [8].

 




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