Right aortic arch with mirror image branching pattern and isolated left brachiocephalic artery: A case report

Abstract

We present a very rare case of right aortic arch with an isolated left brachiocephalic artery in a 35-year-old female. This entity is an extremely uncommon aortic arch anomaly which has associated multisystem symptoms. We briefly discuss the hypothetical double aortic arch model originally described by Edwards. The aortic embryology can explain the anatomic findings and imaging manifestations of the isolated left brachiocephalic artery. Multimodality imaging evaluation can be helpful in detection and categorization of aortic arch abnormalities. A diagnostic imaging approach should focus on elucidating the abnormal aortic arch and great vessels arrangement with determination of associated cardiac, vascular or visceral congenital abnormalities.

Right aortic arch with mirror image branching found incidentally during coronary surgery

“…2 Echocardiography, cardiac magnetic resonance imaging and computed tomographic angiography are all used as imaging modalities to diagnose aortic arch anomalies. 1,3 Coronary angiography is increasingly performed via the radial artery and therefore screening of the descending aorta and arch of the aorta is no longer routine; this may lead to abnormalities of the aorta being missed pre-operatively. 4 RAMI is a rare congenital anomaly, and it is unusual to diagnose it in adulthood.…”

“… 2 Echocardiography, cardiac magnetic resonance imaging and computed tomographic angiography are all used as imaging modalities to diagnose aortic arch anomalies. 1 , 3 …”