Author(s)

A.Ragozzino, S.Romano, R.De Ritis, G.Esposito, M.Scaglione

Patient

male, 10 year(s)

A 10-year-chid with cronic cough and normal findings at clinical tests. MRA was performed.

A 10-year-old boy complaining of cronich cough and intermittent fever was admitted to our attention; clinical tests (such as RAST test,esophageal pHmetry, echocardiography) and the plain film examination of the thorax showed no abnormality. A bronchoscopy was recommended because of severe symptomatology, showing a narrowing of the tracheal lumen for a posterior wall protrusion. MRA was perfomed, revealing the anomlous origin of the right subclavian artery from the posterior aortic arch, coursing behind the esophagus.Right carotid artery arose from the aortic arch just immediately before the left corresponding vascular branch. Surgery confirmed the presence of MR findings of a vascular ring, which was dissected with subsequent suture of the proximal right subclavian artery, making an anastomosis betwen the arteria lusoria and the right carotid artery.The postoperative course was characterized by a transient arterial hypertension.Three months later, the MR showed the perviety of the vascular anastomosis.

The aberrant origin of a subclavian artery is a rare entity that leads to develop a vascular ring, in which the trachea and the esophagus are surrounded by vascular structures. In the childhood this condition is rarely symptomatic and usually associated to other cardiac anomalies, occurring in approximately 1 in 200 births, presenting a predominancy in female sex. It's important to consider a vascular anomaly in the differential diagnosis of patients with respiratory illness of obsure origin. In our case, a tracheomalacia was suspected at first, whereas conventional x-ray examination and other tests excluded respiratory affections,gastroesophageal reflux, mediastinic masses and cystic fibrosis. MRA revealed the course of the anomalous artery and its relationship between the esophagus and the tracheal lumen. The aberrant righ subclavian artery is a congenital disease causing atypical symptoms and may be misdiagnosed in the childhood. MRA examination represent a valuable tool to detect the vascular abnormality in the children, also because using no-ionizing radiations.