Fact-sheet: Right-sided aortic arch


Updated on 12/11/2024 at 10:38 AM

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Definition

Anatomic variant of the aortic arch, the course of which is located to the right of the trachea.

Clinical features

Usually an incidental finding.

Occasionally, signs related to esophageal and/or tracheal compression by an associated vascular anomaly.

Occasionally, signs related to an associated cyanotic congenital heart disease.

Radiography

Absence of visualization of the left aortic border

Leftward deviation of the trachea at the level of the right-sided aortic arch

Mediastinal widening on the side of the right-sided aortic arch

Right-sided descending thoracic aorta

CT

Reference examination.

Contrast-enhanced arterial phase aortic CT angiography, allowing differentiation of the various types of right-sided aortic arch (see "Classification").

MRI

Findings similar to CT.

Classification

  • Type 1: Origin of the left brachiocephalic trunk first, followed by the common carotid artery then the right subclavian artery
  • Often associated with cyanotic congenital heart disease (Tetralogy of Fallot, truncus arteriosus, tricuspid atresia, transposition of great arteries)
  • Type 2: Right-sided aortic arch with aberrant left subclavian artery
  • associated with a Kommerell diverticulum
  • Origin of the left common carotid artery first, followed by the common carotid artery, the right subclavian artery, then the left subclavian artery
  • Possible esophageal and/or tracheal compression by the left subclavian artery
  • Rarely associated with other cardiovascular anomalies
  • Type 3: Right-sided aortic arch with isolated left subclavian artery
  • May be associated with subclavian steal and vertebrobasilar insufficiency
  • Rarely associated with congenital heart disease