Aortic arch anomalies - Vascular ring (Developmental basis)

Images are from Freedom's CHD Textbook of Angiography Vol. II (1997) p.948.

Based on Edwards Hypothetical Double Arch.

Numbers in lower diagram indicate possible sites of regression. Vascular anomalies occur according to the site of regression.

Normal left arch - 1, 7 regress.

Right arch with mirror-image branching - 2,8 regress.

Left arch with aberrant RSCA - 1, 3 regress.

Right arch with aberrant LSCA - 2,6 regresss.

Figure out other vascular anomalies...similarly:

   Double arch - both arches patent

   Double arch with atresia of a segement of left arch

   Double arch with atresia of a segement of right arch

   Left arch with right descending aorta

   Left arch with isolation of RSCA

   Right arch with left ductus (retroesophageal)

   Right arch with isolation of LSCA

   Right arch with aberrant left innominate artery

   Right arch with isolation of left innominate artery

Anatomy: Left Aortic Arch with Right Descending Aorta

Left Aortic Arch with Right Descending Aorta: Possible type
(From Esophagography in anomalies of the aortic arch system by A.C. Klinkhamer. 1969. Williams & Wilkins Company, Baltimore, MD)
See related posting

Vascular Ring - General Rules

From Moss & Adams(Vol. 1) 7th ed. 2008.
Chapter: Aortic Arch Anomalies by Dr. Paul Weinberg.

1) Arch sidedness: Retroesophageal or Isolated vessel always is the vessel on opposite side from the arch.

2) Vascular Ring: Easier to recognize the existence of vascular ring if all components of the ring are patent. The following rule is helpful when the ring is completed by an atretic ligament on one side i.e. Presence of one of the 3 Ds on the opposite side from the aortic arch indicates presence of a vascular ring. (3Ds are Diverticulum, Dimple or Descending aorta).

Vascular Ring Analysis using Edwards Hypothetic Aortic Arches

Moss and Adams (Fifth Edition)

Anatomy: Aberrant RSCA, Pulmonary Sling, Barium Swallow

Aberrant Subclavian Artery Origin

(RSCA crosses midline, posterior to esophagus)

Netter diagram

Pulmonary Sling: Origin of LPA from RPA

(LPA crosses midline anterior to esophagus, inbetween esophagus & trachea)

(Diagrams below are from Esophagography in Anomalies of Aortic Arch System. A.C. Klinkhamer. The Williams & Wilkins Company, Baltimore MD. 1996)

How to use the Table:

1. First, review plain CXR (PA view; High dose film) - Ascertain aortic arch sidedness & position of descending aorta in thorax.

2. Second, study Barium Swallow Study - Usually Frontal and Oblique views (Note: Lateral view is ideal for Pulmonary sling and Double aortic arch, but not useful in other anomalies)

Image source: Esophagography in anomalies of the aortic arch system. A.C. Klinkhamer. The Williams & Wilkins Company, Baltimore, MD. 1969. Copyright - Excerpta Medica Foundation.

Related link: Barium Swallow