engleski

Double aortic arch in adult patient – roentgenology and computed tomography imaging

A double aortic arch (DAA) is a vascular anomaly that usually occurs in the fifth week of gestation due to the lack of regression of the right-sided aortic arch and its association with the normal left-sided aortic arch into a true vascular ring encompassing the esophagus and trachea. Consequences of the compressive effect of the DAA pathoanatomical substrate on the aero-digestive tract include respiratory insufficiency, cyanosis, dysphagia, and gastroesophageal reflux disease. It is usually diagnosed in early childhood, although literature reports several adult cases diagnosed postmortem. The prevalence of this anomaly is estimated at 1%, although exact epidemiological data are lacking. We present a 45- year-old female patient diagnosed with DAA after a radiological evaluation during hospitalization due to numerous comorbidities: tuberous sclerosis, pulmonary lymphangioleiomyomatosis, chronic obstructive pulmonary disease, kidney transplantation, and sporadic pneumothorax. The frontal chest radiograph demonstrates an enlarged shadow of the superior right mediastinum that looks like a mirror image of the shadow of a normal aortic arch. The trachea can be circumferentially narrowed, making its transparency look like an hourglass. Enlarged cardiac silhouette and elongated aorta are results of aortic stenosis. Lungs and pulmonary hila findings are within physiological limits. The computed tomography (CT) findings are typical: the aortic arch annularly encloses the esophagus and trachea and, to some extent, compresses them with consequent luminal narrowing. A unenhanced CT scan is sufficient to confirm the DAA, while a detailed analysis requires aortography.

double aortic arch ; roentgenology ; computed tomography imaging

Rad je izrađen u Kliničkom zavodu za dijagnostičku i intervencijsku radiologiju Kliničke bolnice Dubrava u Zagrebu.