A right-sided aortic arch is an aortic arch that crosses over the right main stem bronchus instead of the usual left main stem bronchus. A vascular ring is a malformation where vascular branches encircle the trachea and oesophagus. When the circle around the trachea and oesophagus is incomplete, the malformation is called vascular sling. In most cases, a right-sided aortic arch is present. In a double aortic arch (one of the most common vascular ring malformation patterns), the two arches encircle the trachea and oesophagus.
Symptoms of vascular ring, including stridor, wheezing and dysphagia, are due to compression of the trachea or oesophagus. If compression is minimal, vascular rings may be asymptomatic and diagnosed as incidental findings. A 37-year-old man presented with a history of chest discomfort, progressive mild dyspnoea on exertion and intermittent dysphagia for solids and liquids. Chest X-ray showed right aortic arch.
Magnetic resonance (MR) angiography showed right aortic arch, separated origin of right carotid and right subclavian arteries, and common origin of left carotid and left subclavian arteries (like a “brachiocephalic trunk”) from the ascending aorta. MR angiography also identified an aberrant subclavian artery, originating from the right descending aortic arch, coursing behind the oesophagus and trachea, and, after union with the left subclavian artery, creating the vascular ring ( Fig. 1 ). Concomitant three-dimensional coronary MR angiography excluded associated coronary abnormalities ( Fig. 2 ).
