British Journal of Radiology (2007) 80, e260-e264
© 2007 British Institute of Radiology
doi: 10.1259/bjr/30659566
MR angiography of left-sided cervical aortic arch with aberrant right subclavian artery
M Haliloglu, MD
1
M Karcaaltincaba, MD
1
B Oguz, MD
1 and
A Celiker, MD
2
Departments of 1 Radiology and 2 Paediatric Cardiology, Hacettepe University School of Medicine, 06100 Ankara, Turkey
Correspondence: Mithat HalilogluMD, Department of Radiology, Hacettepe University Faculty of Medicine, Sihhiye, 06100 Ankara, Turkey. E-mail: mhall{at}tr.net
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Abstract
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Cervical aortic arch is a rare anomaly. We report the contrast-enhanced MR angiography features of left-sided cervical aortic arch with contralateral descending aorta and aberrant right subclavian artery in a 16-year-old girl.
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Case report
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A 16-year-old girl presented with a Grade 2/6 systolic murmur in the base of the neck on the left side. Chest radiograph showed left-sided superior mediastinal widening (Figure 1
). Echocardiography demonstrated a small atrial septal defect and turbulent flow in the descending aorta. MR imaging was performed on a 1.5 T scanner (Symphony; Siemens Medical Systems, Erlangen, Germany) using a phased array body coil. Three-dimensional (3D) gradient echo coronal MR angiography sequence was obtained with the following paramaters; repetition time/echo time (TR/TE), 3.8/1.4 milliseconds (ms); flip angle, 25°; slice thickness, 1.3 mm; matrix, 176x256; field of view (FOV), 430 mm; acquisition time, 18 s. Two consecutive measurements were obtained. 9 ml of Gd-DTPA was administered with a power injector at a rate of 2 ml s–1.
MR angiography demonstrated a high left-sided cervical aortic arch (Figure 2) with contralateral descending aorta and aberrant right subclavian artery originating from the aortic diverticulum on the right side (Figure 3a). The first branch originating from the arch was the right common carotid artery. The left vertebral artery directly originated from the aortic arch (Figure 3b). The aortic arch was elongated and tortuous.
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Figure 2. Coronal source image shows the high location of the aortic arch which is left-sided (arrow).
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Figure 3. (a) Three-dimensional (3D) volume-rendered MR angiography of the aortic arch from an anterior aspect demonstrates left-sided aortic arch with contralateral descending aorta. Branches arising from the aorta are the right common carotid artery (RCCA), left common carotid artery (LCCA), left subclavian artery (LSCA) and aberrant right subclavian artery (ARSA). (b) 3D volume-rendered MR angiography of the aortic arch from an posterior aspect shows the left vertebral artery (LVA) arising from the aortic arch directly. Note early bifurcation of the left common carotid artery.
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Discussion
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During embryogenesis, six pairs of dorsal aortic arches (branchial arches) develop. By involution of some and persistence of others, the normal anatomy develops. Variations in this sequence of development cause numerous aortic arch anomalies. There are several theories explaining the cervical aortic arch: (a) persistence of the second or third branchial arch combined with the resorption of the fourth branchial arch; (b) lack of caudal migration of an otherwise normal fourth arch; and (c) fusion between the third and fourth arches, combined with failure to descend into the thorax [1].
Cervical aortic arch is defined when the aortic arch is supraclavicular. Many patients with cervical aortic arch are asymptomatic, whereas others present with respiratory symptoms or dysphagia due to compression of the trachea or oesophagus by a vascular ring. Cervical aortic arch abnormalities can be classified into five types according to the configuration of the aorta, sequence of brachiocephalic branching and embryogenesis [2]. According to that particular classification: type A, contralateral descending aorta and absence of one common carotid artery (separate external and internal carotid artery branches); type B, contralateral descending aorta and presence of both common carotid arteries; type C, contralateral descending aorta and bicarotid trunk; type D, ipsilateral descending aorta with normal sequence of brachiocephalic branching; type E, right aortic arch and right descending aorta. Our case was consistent with type B cervical aortic arch.
Contrast-enhanced 3D MR angiography has been used for evaluation of the cervical aortic arch and its branching pattern [3]. To our knowledge, this is the first case of left-sided cervical aortic arch with contralateral descending aorta and aberrant right subclavian artery demonstrated by contrast-enhanced 3D MR angiography.
Received for publication November 9, 2005.
Revision received April 3, 2006.
Accepted for publication August 24, 2006.
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References
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- Doorenbos BM, Mooyaart EL, Hoorntje JCA. MR diagnosis of a right cervical aortic arch. J Comput Assist Tomogr 1991;15:864–6.[Medline]
- Haughton VM, Fellows KE, Rosenbaum AE. The cervical aortic arches. Radiology 1975;114:675–81.[Abstract]
- Ogawa S, Ozaki Y, Sumi Y, Kyogoku S, Maehara T. MR angiography of left-sided cervical aortic arch with aneurysm formation. Magn Reson Imaging 2002;20:615–8.[CrossRef][Medline]
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Abstract
Case report
