Right Aortic Arch

Patient History

The patient is a 18-month-old girl with Klippel-Trenaunay-Weber syndrome. At age 10 months she was noted on bronchoscopy to have a pulsatile mass compressing the right main stem bronchus. An esophagram was performed and showed a large posterior indentation on the esophagus that was smooth in contour. On the AP film the indentation appeared to run at an angle. During the courses of the examination gastroesophageal reflux was noted. The findings in the esophagus were compatible with either a double aortic arch or an aberrant subclavian artery.

At age 11 months, she had a barium swallow which showed the presence of a vascular ring. An MRI chest exam was performed to further investigate this finding and characterize it.

The MRI examination consisted of axial, coronal, and parasagittal t1 weighted images of the chest. The study revealed thee presence of a right-sided aortic arch. A Kumeral's diverticulum is present and is positioned just to the left side of the right-sided aortic arch. The original MRI report stated that the left common carotid and left subclavian arteries arose from the Kumeral's diverticulum. TCV surgery requested further review of the study to better delineate the origin of the left common carotid artery. Volumetric analysis of the MRI showed that only the left subclavian artery arose from the Kumeral's diverticulum.

Contributions of Volumetric Imaging to Case Outcome

Oblique Sectioning showed that the left common carotid artery was the first vessel off the aortic arch. This was and extremely important finding because had the left common carotid originated posteriorly from the Kumeral's diverticulum the patient would not have been a candidate for corrective surgery.

Orientation Slices

Last modified: Wed Jun 2 11:40:59 CDT

Right Aortic Arch

Patient History

Contributions of Volumetric Imaging to Case Outcome

Orientation Slices

MPEG Movies

Original coronal view.

Original axial view.

Surface Rendering