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Objectives First, to estimate the prevalence of fetal aberrant right subclavian artery (ARSA) in our population and its association with Down syndrome. Second, to determine the feasibility of ultrasound to visualize ARSA in the three planes. Finally, to carry out a systematic review of the literature on the performance of second-trimester ARSA to identify fetuses with Down syndrome. Methods ARSA was assessed by ultrasound in the axial plane and confirmed in the longitudinal and coronal planes during the second half of pregnancy in women attending our unit (from February 2011 to December 2012). A search of diagnostic tests for the assessment of ARSA was carried out in international databases. Relevant studies were subjected to a critical reading, and meta-analysis was performed with Meta-DiSc. Results Of the 8781 fetuses in our population (mean gestational age: 24 ± 5.4 weeks), 22 had Down syndrome. ARSA was detected in the axial view in 60 cases (0.7%) and confirmed in the coronal view in 96.7% and in the longitudinal view in 6.7% (P < 0.001). Seven cases with ARSA had Down syndrome and all were in the non-isolated-ARSA group. The estimates of positive likelihood ratio (LR) were 0 for isolated ARSA and 199 (95% CI, 88.9–445.2) for non-isolated ARSA. In the systematic review, six studies were selected for quantitative synthesis. The pooled estimates of positive and negative LRs for global ARSA were, respectively, 35.3 (95% CI, 24.4–51.1) and 0.75 (95% CI, 0.64–0.87). For isolated ARSA, the positive and negative LRs were 0 (95% CI, 0.0–14.7) and 0.98 (95% CI, 0.94–1.02), respectively. Conclusions The prevalence of ARSA seems close to 1%. The coronal plane is the most suitable for its confirmation after detection in the axial plane. Detection of isolated or non-isolated ARSA should guide decisions about karyotyping given that isolated ARSA shows a weak association with Down syndrome., Depto. de Salud Pública y Materno - Infantil, Fac. de Medicina, TRUE, pub

History of present illness: A 25-year-old male with a history of asthma presented to the emergency department (ED) with the sensation of food impaction in the mid-thoracic region and inability to swallow that began twenty minutes prior to arrival after eating chicken. Careful history revealed that the patient had several ED visits for similar episodes during his early childhood. Physical examination was benign with stable vitals. He had a clear oropharynx and normal breath sounds bilaterally. On cardiac auscultation, there was a regular rate and rhythm without appreciable murmur. Significant findings: After an unremarkable chest radiograph was obtained, a computed tomography (CT) scan of the chest was obtained due to possible co-ingestion of bones to rule out perforation. The CT scan demonstrated focal distention of the mid-esophagus due to an impacted food bolus (white arrow). An aberrant right subclavian artery (yellow arrow) was located just distal to the impaction site with partial compression of the esophagus (red arrow). Discussion: Arteria lusoria is an aberrant right subclavian artery. It is the most common embryologic abnormality of the aortic arch, occurring in 0.5% to 1.8% of the population.1 In this condition, the right subclavian artery arises directly off of the aorta, distal to the left subclavian artery, as opposed to the normal branching off the right brachiocephalic artery. While the majority of cases are asymptomatic, occasionally the artery will compress adjacent structures including the trachea and esophagus.2 This phenomenon was first described in 1794 by a London physician who remarked on a fatal case of "obstructed deglutition.”3 When the aberrant right subclavian artery causes compression and trachea-esophageal symptoms such as dysphagia, it is termed dysphagia lusoria. The patient was diagnosed with dysphagia lusoria and given an intravenous bolus of glucagon with resolution of symptoms in one hour. He was able to tolerate liquids

History of present illness: A 25-year-old male with a history of asthma presented to the emergency department (ED) with the sensation of food impaction in the mid-thoracic region and inability to swallow that began twenty minutes prior to arrival after eating chicken. Careful history revealed that the patient had several ED visits for similar episodes during his early childhood. Physical examination was benign with stable vitals. He had a clear oropharynx and normal breath sounds bilaterally. On cardiac auscultation, there was a regular rate and rhythm without appreciable murmur. Significant findings: After an unremarkable chest radiograph was obtained, a computed tomography (CT) scan of the chest was obtained due to possible co-ingestion of bones to rule out perforation. The CT scan demonstrated focal distention of the mid-esophagus due to an impacted food bolus (white arrow). An aberrant right subclavian artery (yellow arrow) was located just distal to the impaction site with partial compression of the esophagus (red arrow). Discussion: Arteria lusoria is an aberrant right subclavian artery. It is the most common embryologic abnormality of the aortic arch, occurring in 0.5% to 1.8% of the population.1 In this condition, the right subclavian artery arises directly off of the aorta, distal to the left subclavian artery, as opposed to the normal branching off the right brachiocephalic artery. While the majority of cases are asymptomatic, occasionally the artery will compress adjacent structures including the trachea and esophagus.2 This phenomenon was first described in 1794 by a London physician who remarked on a fatal case of "obstructed deglutition.”3 When the aberrant right subclavian artery causes compression and trachea-esophageal symptoms such as dysphagia, it is termed dysphagia lusoria. The patient was diagnosed with dysphagia lusoria and given an intravenous bolus of glucagon with resolution of symptoms in one hour. He was able to tolerate liquids

Keet, K., Gunston, G., & Alexander, R. (2019). Variations in the branching pattern of the aortic arch: An African perspective. European Journal of Anatomy, 23(2), 91-102. Available here