The authors present a 12-year-old male with an asymptomatic absence of the proximal right subclavian artery. On physical examination, his right brachial, radial, and ulnar pulses were diminished compared with the left side. Computed tomographic angiography revealed that the right subclavian artery was supplied from the anterior right internal mammary artery. A description of the acquired and congenital aortic arch anomalies and thoracic outlet syndrome differential diagnoses is provided.
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