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First published online September 15, 2008
British Journal of Radiology (2009) 82, 73-78
© 2009 British Institute of Radiology
doi: 10.1259/bjr/44929969
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Non-invasive imaging of aberrant right subclavian artery pathologies and aberrant right vertebral artery

M KARCAALTINCABA, MD 1 M HALILOGLU, MD 1 E OZKAN, MD 1 M KOCAK, MD 2 D AKINCI, MD 1 and M ARIYUREK, MD 1

1 Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey, 2 Department of Radiology, Medical College of Wisconsin, Milwaukee, WI, USA


Figure 1
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  		Figure 1. A diagram showing the normal embryological development of the aortic arch and the development of an aberrant right subclavian artery(ARSA). (a) Normal embryological anatomy of aortic arches are displayed. (b) During normal development, most of the aortic arches involute and the 4th arch forms the aortic arch. Also, the right dorsal aorta involutes. (c) ARSA develops as a result of persistent right dorsal aorta (known as Kommerell's diveritculum) and involution of the right 4th embryologic arch. Emrbyological aortic arches are represented in purple and involuted ones in grey. Arches in red represent persistent embryological structures in adult life (b,c).

 

Figure 2
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  		Figure 2. A 35-year-old man with an incidentally diagnosed aberrant right subclavian artery (ARSA). (a) On CT angiography (left anterior oblique projection), the ARSA is seen as the last branch from the aortic arch (arrow). (b) CT angiography (posterior projection) shows the ARSA as the only posterior branch (arrow). (c) An axial image shows the ARSA posterolateral to the oesophagus (arrow).

 

Figure 3
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  		Figure 3. A 2-year-old girl with an aberrant right subclavian artery (ARSA) aneurysm and truncus arteriosus anomaly. (a,b) CT angiography (left posterior and superior projections) images show a dilated ARSA and fusiform aneurysm (long arrow). Note the left pulmonary artery (short arrow) arising from the aortic arch (double arrow). (c) Coronal multiplanar reformatted image shows narrowing of the left pulmonary artery (arrow) between the ARSA aneurysm (asterisk) and the aortic arch (AA). (d) An axial CT image showing the ARSA (asterisk) traversing posterior to the aortic arch and indenting the posterior wall of the trachea (T).

 

Figure 4
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  		Figure 4. A 40-year-old woman with Takayasu arteritis and aberrant right subclavian artery (ARSA) involvement, resulting in right-sided subclavian steal. (a,b) CT angiography (superior left anterior oblique and left posterior oblique projections) shows severe stenosis of the ARSA (arrow). Note that vasculitis involves the retro-oesophageal segment, sparing the distal ARSA and Kommerell's diverticulum. (c) Axial CT image shows the normal calibre of the Kommerell's diverticulum (arrow). (d) Coronal thin maximum intensity projection image demonstrates wall thickening and narrowing of the ARSA, consistent with vasculitis. These findings were not visible on conventional angiography.

 

Figure 5
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  		Figure 5. A 42-year-old man with right vertebral artery (RVA) dissection (arrow) and aberrant right subclavian artery (ARSA). (a,b) MR angiography, coronal thin maximum intensity projection and coronal volume-rendered projections show a dissected vertebral artery arising from the ARSA. (c,d). Diffusion-weighted MR image and head CT image show infarct in the right cerebellum as a result of dissection.

 

Figure 6
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  		Figure 6. A 59-year-old woman with an incidentally diagnosed aberrant right vertebral artery (RVA). (a) Axial CT image shows the retro-oesophageal course of the aberrant RVA. (b) Curved planar reformatted image shows the aberrant RVA traversing towards the right vertebral canal. (c,d) CT angiography (left posterior oblique projections) shows the aberrant RVA as the last branch from the posterior aspect of the aortic arch. Kommerell's diverticulum (arrow) is also seen at the origin of the aberrant RVA. LCCA, left common carotid artery; RCCA, right common carotid artery; LVA, left vertebral artery; LSA, left subclavian artery; RSA, right subclavian artery. Reprinted with permission from [6].

 




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