Aberrant right subclavian artery
Updates to Article Attributes
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was changed:
Aberrant right subclavian arteries (ARSA), also known as arteria lusoria, are the commonest of the aortic arch anomalies2.
Epidemiology
The estimated incidence is 0.5-2%.
Clinical presentation
They are often asymptomatic, but around 10% of people may complain of have dysphagia lusoria 3.
Pathology
Course
Instead of being the first branch (with the right common carotid as the brachiocephalic artery), it arises on its own as the fourth branch, after the left subclavian artery. It then hooks back to reach the right side. Its relationship to the oesophagus is variable:
- 80% posterior to oesophagus
- 15% between oesophagus and trachea
- 5% anterior to the trachea
Associated anomalies
- as can be expected from embryology, the right recurrent laryngeal nerve is
often absentusually non-recurrent (that is, enters the larynx directly). - aneurysmal dilatation (aberrant subclavian arterial aneurysms) of the proximal portion of an aberrant right subclavian artery can occur, a pouch like aneurysmal dilatation is called a diverticulum of Kommerell
- if there is a retro-oesophageal course:
- it can get compressed between the oesophagus and the vertebra
- the incidence of stenosis/occlusion in this segment is higher
- it can be associated with trisomy 21, trisomy 18 and other chromosomal defects.
Radiographic features
Fluoroscopy
An upper GI contrast study will demonstrated displacement of the contrast-filled oesophagus. This displacement by the aberrant vessels produces the so-called bayonet deformity of aberrant right subclavian artery.
-<li>as can be expected from <a href="/articles/embryology">embryology</a>, the right <a href="/articles/recurrent-laryngeal-nerve">recurrent laryngeal nerve</a> is often absent </li>- +<li>as can be expected from <a href="/articles/embryology">embryology</a>, the right <a href="/articles/recurrent-laryngeal-nerve">recurrent laryngeal nerve</a> is usually non-recurrent (that is, enters the larynx directly). </li>
-<li>it can be associated with <a href="/articles/down-syndrome">trisomy 21</a>, <a href="/articles/edward-syndrome">trisomy 18</a> and other chromosomal defects.</li>- +<li>it can be associated with <a href="/articles/down-syndrome">trisomy 21</a>, <a href="/articles/edwards-syndrome-1">trisomy 18</a> and other chromosomal defects.</li>
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