A unique case of right cervical aortic arch with anomalous left common carotid artery and absent right common carotid artery

摘要

Introduction Cervical aortic arch is a rare anomaly where-in the ascending aorta arises normally from the left ventricle and extends in such a fashion that the aortic arch is situated high in the neck on either side. This anomaly should be suspected in any child exhibiting a pulsatile swelling in the neck. Case commentary An 8 year old child presented with a pulsatile swelling on the right side of the neck since birth. CT angiography revealed right sided cervical aortic arch at C4-C5 level. The left common carotid artery arose from the ascending aorta at D4 with the right external and internal carotid arteries originating separately from the cervical arch. The right and left subclavian arteries arose from the descending aorta at D1 and D4 respectively. Discussion Although most patients with cervical aortic arch are asymptomatic, some have dysphagia from oesophageal compression and respiratory distress from tracheal compression. There are many anatomical variations in cervical aortic arch as mentioned by Haughton. This case is Haughton type A because apart from the presence of right cervical aortic arch, 2 additional oddities in the form of leftward descending aorta and abnormal origin of the left common carotid artery from ascending aorta with absence of right common carotid artery are noted. Conclusion Cervical aortic arch is not a very commonly encountered entity and can be quite vexing for those who are seeing such a case in OPD for the first time. Although cervical aortic arch anomalies have been reported in literature, published reports of new cases will help to increase awareness regarding this anomaly and lead to a swift and efficient diagnosis and management. Highlights ? An 8 year old male presented with a pulsatile swelling in right carotid triangle since birth. CT angiography revealed right sided cervical aortic arch with left common carotid artery arising from ascending aorta and the right external and internal carotid arteries originating separately from cervical arch. ? This rare anomaly arises from interruption of embryological 3rd and 4th arches with regression of fourth arch leading to persistence of right second or third brachial arches. ? This case is Haughton type A. ? Cervical aortic arch is not a very commonly encountered entity and can be quite vexing for those who are seeing such a case in OPD for the first time. Although cervical aortic arch anomalies have been reported in literature, published reports of new cases will help to increase awareness regarding this anomaly and lead to a swift and efficient diagnosis and management.