Figure 1
Postcontrast Computed Tomography – Angiography axial image
An aberrant right subclavian artery (arteria lusoria) which originates from the aortic arch, crosses the midline between the spine and the oesophagus.
Arteria lusoria and truncus bicaroticus: a case report
SectionCardiovascular
Case TypeClinical Cases
AuthorsKhouloud Boussouni, I. Taam, A. El Hankari, L. Jroundi
Connected authors
43 years, male
Clinical History
A 43-year-old male patient was referred to our department for Computed Tomography (CT) angiography to eliminate a pulmonary embolism. He was admitted to intensive care for severe head trauma. His medical history was unremarkable. There was no dysphagia or dyspnoea.
Imaging Findings
Computed Tomography (CT) angiography was performed and incidentally revealed:
An aberrant right subclavian artery (arteria lusoria) which originates from the aortic arch
(Fig. 1) and crosses the midline between the spine and the oesophagus (Fig. 2) to reach the right side (Fig. 3). Both common carotid arteries originate from a common trunk .There was no abnormality of origin of the left subclavian artery (Fig. 2, 4, 5).
CT angiogram with 3D reconstruction (Fig. 5) shows a common origin of bilateral carotid arteries arising from the aortic arch who is called a truncus bicaroticus associated with arteria lusoria.
An aberrant right subclavian artery (arteria lusoria) which originates from the aortic arch
(Fig. 1) and crosses the midline between the spine and the oesophagus (Fig. 2) to reach the right side (Fig. 3). Both common carotid arteries originate from a common trunk .There was no abnormality of origin of the left subclavian artery (Fig. 2, 4, 5).
CT angiogram with 3D reconstruction (Fig. 5) shows a common origin of bilateral carotid arteries arising from the aortic arch who is called a truncus bicaroticus associated with arteria lusoria.
Discussion
Aberrant right subclavian artery (ARSA) or arteria lusoria is the most common congenital aortic arch anomaly with a reported prevalence of 0.4–2% [1].
It is commonly associated with other congenital anomalies of the heart and great vessels resulting from embryologic malformation of the aortic arch, including truncus bicaroticus, which is a common trunk of bilateral common carotid arteries [2]. The association of ARSA and truncus bicaroticus is somewhat rare (about 29%) [3].
Arteria lusoria results from abnormal embryologic development of the aortic arch. The abnormal arterial origin is explained by the involution of the right fourth vascular arch with the proximal right dorsal aorta and the persistence of the right seventh intersegmental artery, which remains attached to the dorsal aorta: after the rotation of the dorsal aorta, the right seventh intersegmental artery becomes the ARSA. The artery crosses the midline between the oesophagus and vertebral column to reach the right side [4, 5].
Arteria lusoria is usually asymptomatic and is most often discovered incidentally during evaluation of other mediastinal anomalies, such as in our case. When symptomatic, the ARSA causes dysphagia lusoria from oesophageal compression, or dyspnoea and chronic coughing from tracheal compression. Truncus bicaroticus is a precondition for tracheal–oesophageal compression and the development of clinical symptoms [3, 4, 5]. Other symptoms are much rarer and are signs of aneurysmal dilatation of the proximal lusorian artery [6].
The diagnosis is based primarily on findings at chest radiography in association with those at oesophogography. The lateral projection chest radiography show the ARSA as a round, localized density continuous with the superior margin of the aortic arch [7].
MDCTA (multidetector row computed tomography angiography) and conventional angiography, including direct catheterization of the aberrant right subclavian artery, confirm the diagnosis [1].
Magnetic Resonance Angiography (MRA) is a non-invasive imaging modality and the most suited, currently used in the evaluation of thoracic aortic malformation including arteria lusoria and truncus bicaroticus [8].
There are several treatment options for an arteria lusoria. Surgical, endovascular, or combined interventions can be used. Treatment is indicated in symptomatic cases and also for prevention of complications due to aneurysmal dilatation of the lusorian artery.
Most patient with arteria lusoria are asymptomatic and rarely need a treatment [9].
Such was the case of our patient who was not operated due to the asymptomatic nature of the anomaly.
It is commonly associated with other congenital anomalies of the heart and great vessels resulting from embryologic malformation of the aortic arch, including truncus bicaroticus, which is a common trunk of bilateral common carotid arteries [2]. The association of ARSA and truncus bicaroticus is somewhat rare (about 29%) [3].
Arteria lusoria results from abnormal embryologic development of the aortic arch. The abnormal arterial origin is explained by the involution of the right fourth vascular arch with the proximal right dorsal aorta and the persistence of the right seventh intersegmental artery, which remains attached to the dorsal aorta: after the rotation of the dorsal aorta, the right seventh intersegmental artery becomes the ARSA. The artery crosses the midline between the oesophagus and vertebral column to reach the right side [4, 5].
Arteria lusoria is usually asymptomatic and is most often discovered incidentally during evaluation of other mediastinal anomalies, such as in our case. When symptomatic, the ARSA causes dysphagia lusoria from oesophageal compression, or dyspnoea and chronic coughing from tracheal compression. Truncus bicaroticus is a precondition for tracheal–oesophageal compression and the development of clinical symptoms [3, 4, 5]. Other symptoms are much rarer and are signs of aneurysmal dilatation of the proximal lusorian artery [6].
The diagnosis is based primarily on findings at chest radiography in association with those at oesophogography. The lateral projection chest radiography show the ARSA as a round, localized density continuous with the superior margin of the aortic arch [7].
MDCTA (multidetector row computed tomography angiography) and conventional angiography, including direct catheterization of the aberrant right subclavian artery, confirm the diagnosis [1].
Magnetic Resonance Angiography (MRA) is a non-invasive imaging modality and the most suited, currently used in the evaluation of thoracic aortic malformation including arteria lusoria and truncus bicaroticus [8].
There are several treatment options for an arteria lusoria. Surgical, endovascular, or combined interventions can be used. Treatment is indicated in symptomatic cases and also for prevention of complications due to aneurysmal dilatation of the lusorian artery.
Most patient with arteria lusoria are asymptomatic and rarely need a treatment [9].
Such was the case of our patient who was not operated due to the asymptomatic nature of the anomaly.
Differential Diagnosis List
Aberrant right subclavian artery (arteria lusoria) associated with a truncus bicaroticus.
Mediastinal tumour
Other aortic arch vascular malformation
Other anomalies of the right subclavian artery
Final Diagnosis
Aberrant right subclavian artery (arteria lusoria) associated with a truncus bicaroticus.
References
[1] T. Schertler ,S. Wildermuth , N.Teodorovic et al (2007) Visualization of congenital thoracic vascular anomalies using multi-detector row computed tomography and two- and three-dimensional post-processing. European Journal of Radiology 61:97-119 (PMID: 17055684)
[2] Saeed G, Ganster G, Friedel N (2010) Arteria lusoria aneurysm with truncus bicaroticus: surgical resection without restoring blood supply to the right arm. Tex Heart Inst J 37(5):602-607. (PMID: 20978581)
[3] Klinkhamer AC (1966) Aberrant right subclavian artery. Clinical and roentgenologic aspects. Am J Roentgenol Radium Ther Nucl Med 97(2):438-46 (PMID: 5947142)
[4] Bisognano JD, Young B, Brown JM, Gill EA, Fang FC, Zisman LS (1997) Diverse presentation of aberrant origin of the right subclavian artery: two case reports. Chest 112(6):1693-7 (PMID: 9404777)
[5] Carrizo GJ, Marjani MA (2004) Dysphagia lusoria caused by an aberrant right subclavian artery. Tex Heart Inst J 31(2):168-71 (PMID: 15212130)
[6] Murzi M, Mariani M, Tiwari KK,et al (2009) Aberrant right subclavian artery aneurysm in coexistence with a common carotid trunk. Ann Thorac Surg 88(1):e8. (PMID: 19559178)
[7] Branscom JJ, Austin JH (1973) Aberrant right subclavian artery. Findings seen on plain chest roentgenograms. Am J Roentgenol Radium Ther Nucl Med 119(3) :539-42. (PMID: 4758322)
[8] Kastler B, Livolsi A, Germain P et al (2004) [Value of MRI in the evaluation of congenital anomalies of the heart and great vessels]. J Radiol 85 :1821-1850 (PMID: 15507839)
[9] P.O. Myers , J.H.D.Fasel, A. Kalangos , P. Gailloud (2010) Arteria lusoria: Developmental anatomy, clinical,radiological and surgical aspects. Annales de Cardiologie et d’Angéiologie 59: 147–154. (PMID: 19962688)
Case information
| URL: | https://www.eurorad.org/case/13571 |
| DOI: | 10.1594/EURORAD/CASE.13571 |
| ISSN: | 1563-4086 |
License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Figure 2
Postcontrast Computed Tomography – Angiography axial image
Arteria lusoria crosses the midline between the spine and the eosophagus. Both common carotid arteries originate from a common trunk. There is no abnormality of origin of the left subclavian artery.
Figure 3
Postcontrast Computed Tomography – Angiography coronal image
Arteria lusoria originates from the aortic arch, crosses the midline between the spine and the oesophagus to reach the right side.
Figure 4
Postcontrast Computed Tomography – Angiography axial image
Truncus bicaroticus gives rise to the right common carotid artery and the left common carotid artery associated with arteria lusoria.
Figure 5
CT angiogram with 3D reconstruction
Three branches originate from the aortic arch: truncus bicaroticus (who gives rise to the right common carotid artery and the left common carotid artery), arteria lusoria and the left subclavian artery.
Postcontrast Computed Tomography – Angiography axial image
An aberrant right subclavian artery (arteria lusoria) which originates from the aortic arch, crosses the midline between the spine and the oesophagus.
Emergency radiology department ,avicenne hospital,Rabat,Morocco
Emergency radiology department ,avicenne hospital,Rabat,Morocco
Postcontrast Computed Tomography – Angiography axial image
Arteria lusoria crosses the midline between the spine and the eosophagus. Both common carotid arteries originate from a common trunk. There is no abnormality of origin of the left subclavian artery.
Emergency radiology department , avicenne hospital,Rabat,Morocco
Emergency radiology department , avicenne hospital,Rabat,Morocco
Postcontrast Computed Tomography – Angiography coronal image
Arteria lusoria originates from the aortic arch, crosses the midline between the spine and the oesophagus to reach the right side.
Emergency radiology department , avicenne hospital,Rabat,Morocco
Emergency radiology department , avicenne hospital,Rabat,Morocco
Postcontrast Computed Tomography – Angiography axial image
Truncus bicaroticus gives rise to the right common carotid artery and the left common carotid artery associated with arteria lusoria.
Emergency radiology department , avicenne hospital,Rabat,Morocco
Emergency radiology department , avicenne hospital,Rabat,Morocco
CT angiogram with 3D reconstruction
Three branches originate from the aortic arch: truncus bicaroticus (who gives rise to the right common carotid artery and the left common carotid artery), arteria lusoria and the left subclavian artery.
Emergency radiology department , avicenne hospital,Rabat,Morocco
Emergency radiology department , avicenne hospital,Rabat,Morocco