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Right Aortic Arch
Santiago Martínez-Jiménez, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Abbreviations

              • Right aortic arch (RAA)
              • Left aortic arch (LAA)
            • Synonyms

              • Right arch
            • Definitions

              • Aortic arch located to right of trachea
              • Common variations
                • RAA with aberrant left subclavian artery (ALSA) ± Kommerell diverticulum (KD)
                  • Branches: Left common carotid, right common carotid, right subclavian, aberrant left subclavian
                  • KD
                    • Saccular dilatation at proximal ALSA
                    • Implies presence of ligamentum arteriosum and vascular ring
                • RAA with mirror-image branching: Left brachiocephalic, right common carotid, and right subclavian
              • Uncommon variations
                • RAA with left descending aorta (circumflex aorta)
                • RAA with isolation of left subclavian artery
                • RAA with aberrant brachiocephalic artery
                • RAA with unilateral absence of pulmonary artery

            IMAGING

            • General Features

              • Radiographic Findings

                • Fluoroscopic Findings

                  • CT Findings

                    • MR Findings

                      • Echocardiographic Findings

                        • Imaging Recommendations

                          DIFFERENTIAL DIAGNOSIS

                            PATHOLOGY

                            • General Features

                              • Gross Pathologic & Surgical Features

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    • Natural History & Prognosis

                                      • Treatment

                                        DIAGNOSTIC CHECKLIST

                                        • Consider

                                          • Image Interpretation Pearls

                                            Selected References

                                            1. Natsis K et al: A systematic classification of the left-sided aortic arch variants based on cadaveric studies' prevalence. Surg Radiol Anat. 43(3):327-45, 2021
                                            2. Prabhu S et al: Anatomic classification of the right aortic arch. Cardiol Young. 30(11):1694-701, 2020
                                            3. Muraoka M et al: High incidence of progressive stenosis in aberrant left subclavian artery with right aortic arch. Heart Vessels. 33(3):309-15, 2018
                                            4. Arazińska A et al: Right aortic arch analysis: anatomical variant or serious vascular defect? BMC Cardiovasc Disord. 17(1):102, 2017
                                            5. Hanneman K et al: Congenital variants and anomalies of the aortic arch. Radiographics. 37(1):32-51, 2017
                                            6. Tanaka A et al: Kommerell's diverticulum in the current era: a comprehensive review. Gen Thorac Cardiovasc Surg. 63(5):245-59, 2015
                                            7. Etesami M et al: Computed tomography in the evaluation of vascular rings and slings. Insights Imaging. 5(4):507-21, 2014
                                            8. Kanne JP et al: Right aortic arch and its variants. J Cardiovasc Comput Tomogr. 4(5):293-300, 2010
                                            9. Türkvatan A et al: Congenital anomalies of the aortic arch: evaluation with the use of multidetector computed tomography. Korean J Radiol. 10(2):176-84, 2009
                                            10. Holmes KW et al: Magnetic resonance imaging of a distorted left subclavian artery course: an important clue to an unusual type of double aortic arch. Pediatr Cardiol. 27(3):316-20, 2006
                                            11. Weinberg PM: Aortic arch anomalies. J Cardiovasc Magn Reson. 8(4):633-43, 2006
                                            12. Knight L et al: Right aortic arch. Types and associated cardiac anomalies. Circulation. 50(5):1047-51, 1974
                                            Related Anatomy
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                                            Related Differential Diagnoses
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                                            References
                                            Tables

                                            Tables

                                            KEY FACTS

                                            • Terminology

                                              • Imaging

                                                • Top Differential Diagnoses

                                                  • Clinical Issues

                                                    • Diagnostic Checklist

                                                      TERMINOLOGY

                                                      • Abbreviations

                                                        • Right aortic arch (RAA)
                                                        • Left aortic arch (LAA)
                                                      • Synonyms

                                                        • Right arch
                                                      • Definitions

                                                        • Aortic arch located to right of trachea
                                                        • Common variations
                                                          • RAA with aberrant left subclavian artery (ALSA) ± Kommerell diverticulum (KD)
                                                            • Branches: Left common carotid, right common carotid, right subclavian, aberrant left subclavian
                                                            • KD
                                                              • Saccular dilatation at proximal ALSA
                                                              • Implies presence of ligamentum arteriosum and vascular ring
                                                          • RAA with mirror-image branching: Left brachiocephalic, right common carotid, and right subclavian
                                                        • Uncommon variations
                                                          • RAA with left descending aorta (circumflex aorta)
                                                          • RAA with isolation of left subclavian artery
                                                          • RAA with aberrant brachiocephalic artery
                                                          • RAA with unilateral absence of pulmonary artery

                                                      IMAGING

                                                      • General Features

                                                        • Radiographic Findings

                                                          • Fluoroscopic Findings

                                                            • CT Findings

                                                              • MR Findings

                                                                • Echocardiographic Findings

                                                                  • Imaging Recommendations

                                                                    DIFFERENTIAL DIAGNOSIS

                                                                      PATHOLOGY

                                                                      • General Features

                                                                        • Gross Pathologic & Surgical Features

                                                                          CLINICAL ISSUES

                                                                          • Presentation

                                                                            • Demographics

                                                                              • Natural History & Prognosis

                                                                                • Treatment

                                                                                  DIAGNOSTIC CHECKLIST

                                                                                  • Consider

                                                                                    • Image Interpretation Pearls

                                                                                      Selected References

                                                                                      1. Natsis K et al: A systematic classification of the left-sided aortic arch variants based on cadaveric studies' prevalence. Surg Radiol Anat. 43(3):327-45, 2021
                                                                                      2. Prabhu S et al: Anatomic classification of the right aortic arch. Cardiol Young. 30(11):1694-701, 2020
                                                                                      3. Muraoka M et al: High incidence of progressive stenosis in aberrant left subclavian artery with right aortic arch. Heart Vessels. 33(3):309-15, 2018
                                                                                      4. Arazińska A et al: Right aortic arch analysis: anatomical variant or serious vascular defect? BMC Cardiovasc Disord. 17(1):102, 2017
                                                                                      5. Hanneman K et al: Congenital variants and anomalies of the aortic arch. Radiographics. 37(1):32-51, 2017
                                                                                      6. Tanaka A et al: Kommerell's diverticulum in the current era: a comprehensive review. Gen Thorac Cardiovasc Surg. 63(5):245-59, 2015
                                                                                      7. Etesami M et al: Computed tomography in the evaluation of vascular rings and slings. Insights Imaging. 5(4):507-21, 2014
                                                                                      8. Kanne JP et al: Right aortic arch and its variants. J Cardiovasc Comput Tomogr. 4(5):293-300, 2010
                                                                                      9. Türkvatan A et al: Congenital anomalies of the aortic arch: evaluation with the use of multidetector computed tomography. Korean J Radiol. 10(2):176-84, 2009
                                                                                      10. Holmes KW et al: Magnetic resonance imaging of a distorted left subclavian artery course: an important clue to an unusual type of double aortic arch. Pediatr Cardiol. 27(3):316-20, 2006
                                                                                      11. Weinberg PM: Aortic arch anomalies. J Cardiovasc Magn Reson. 8(4):633-43, 2006
                                                                                      12. Knight L et al: Right aortic arch. Types and associated cardiac anomalies. Circulation. 50(5):1047-51, 1974