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Sir .—We read with interest the article by Thoele and colleagues 1 relating their experience in the prereferral diagnosis of coarctation of the aorta (CoA). We agree with them that in the asymptomatic child, the most important reason for a lack of diagnosis is an incomplete physical examination. Several recommendations were made. Palpation of the peripheral pulses and measurement of blood pressures were the most important of these suggestions. However, in our opinion, misleading emphasis was placed on palpation and blood pressure measurement in the right arm, almost to the exclusion of palpation and measurement on both upper extremities. Although Thoele and colleagues are correct in emphasizing that a left subclavian artery arising near or distal to the site of coarctation is not uncommon, an aberrant right subclavian artery can and does occur in a similar fashion. We recently encountered a child first referred at 5½ years of age (the

Magnetic resonance (MR) imaging was performed for evaluation of a right paramediastinal mass in an asymptomatic 84-year-old woman. An aneurysm of an aberrant right subclavian artery was diagnosed. This rare complication of a common congenital anomaly and the use of MR in evaluation is discussed.

Although an aberrant right subclavian artery is the most common congenital anomaly of the aortic arch, with an incidence of one in 200 (Grainger & Allison, 1986), aneurysmal dilatation of this aberrant vessel is quite uncommon. In this report we describe one case which presented initially with a diagnosis of aneurysm of the thoracic aorta. A 72-year-old man was admitted to another hospital for transurethral resection of the prostate. His medical history was unremarkable and he had no other symptoms apart from those relating to his urinary tract. A pre-operative chest radiograph (Fig. 1) showed a bilateral but asymmetrical superior mediastinal mass lying mainly to the left of the midline. The outline of the aortic knuckle was lost and a small curvilinear fleck of calcium was noted in the left lateral margin of the mass (arrowed, Fig. 1). A lateral radiograph of the chest confirmed that the mass did not lie in the posterior mediastinum and a diagnosis of aneurysm of the thoracic aorta was thought most likel...

An aneurysm of an aberrant right subclavian artery was diagnosed with computed tomography (CT) in a 77-year-old man with an asymptomatic mediastinal mass at admission. Although CT clearly demonstrated this rare congenital anomaly, further radiologic study or surgery was not attempted because of the patient's advanced age and lack of symptoms.

Recent observation of one patient suffering from dysphagia lusoria has suggested critical review of treatment of the symptomatic aberrant right subclavian artery. Surgical correction of such an anomaly is difficult and may produce serious complications, and is not always successful. Endoscopic dilatation of the oesophageal stricture, even though it might only produce temporary relief of dysphagia, represents a valid therapeutical alternative because of its favourable cost/benefit ratio, low incidence of complications and patient acceptability.

This paper presents the first description of a ruptured aneurysm of an aberrant right subclavian artery. CT clearly demonstrated the vascular malformation as well as the existence of a bilateral hemothorax.

Aneurysms of an aberrant subclavian artery are rare. They are usually secondary to atherosclerosis. Dysphagia is the most common presenting symptom. The diagnosis of these lesions is most easily established by CT scan. Biplane arteriography is necessary in order to clearly analyze the aortic arch and its branches. Surgical resection is usually indicated. Numerous procedures have been proposed to treat these lesions and controversy exists concerning the best surgical technique. We treated a patient who suffered from an aneurysm of an aberrant subclavian artery. The surgical technique is detailed as well as a review of all the cases of the literature.

Anatomical reestablishment of orthograde flow into the right subclavian artery in children with arteria lusoria is emphasized. We present two infants and one young child who were successfully treated by translocation of the aberrant right subclavian artery to the ascending aorta without graft interposition through a right thoracotomy. Several surgical approaches are reviewed.

In the normal dog only 2 arteries leave the ascending aorta–the brachiocephalic trunk and the left subclavian artery. This communication describes 3 dogs, a labrador, a poodle and a german shepherd, in which 3 large arteries left the ascending aorta–firstly a trunk for both common carotid arteries, then a left subclavian artery and finally a right subclavian artery.

SummaryThe so-called arteria lusoria is an aberrant right subclavian artery arising as the last branch from the aortic arch. Two cases are reported. The embryology of this abnormality as well as the clinical and radiological aspects are described.

There are numerous autopsy reports of aberrant right subclavian artery. The first authenticated case was observed postmortem in 1735 by Hunauld, and Bayford in 1794 designated the dysphagia that may result from such an anomaly as “dysphagia lusoria.” Holzapfel, in 1899, recorded 133 instances discovered at autopsy (6). This is generally stated to be the most common of the congenital anomalies of the aortic arch (7), the incidence being given variously as 4 per thousand autopsies (9) to 12 per thousand (4). The first report of an antemortem diagnosis of aberrant right subclavian artery was in the foreign literature; only in recent years have references to this anomaly appeared in the American literature. Copleman in 1945 described a case and was able to find only four reported cases up to that time in which the diagnosis was made during life (1, 3). Stauffer and Pote in 1946 (8) further stimulated interest in this anomaly, and Neuhauser in the same year (7) discussed it. Brean and Neuhauser in 1947 collect...

Aberrant right subclavian artery is the most common anomaly of the aortic arch. Patients are often asymptomatic and discovered accidentally. Occasionally, they present with symptoms related to oesophageal or tracheal compression. A 13-year-old girl presented with dysphagia and stridor was found to have an aberrant right subclavian artery. Surgical division and reconstruction of the artery was performed initially through right supraclavicular approach. An additional left thoracotomy was performed to overcome the challenges encountered at initial operation.

Aberrant right subclavian artery with coexisting common carotid trunk is an extremely rare congenital anomaly affecting

A nonrecurrent inferior laryngeal nerve (NRILN) is found more frequently on the right side than on the left, and it is closely associated with an aberrant right subclavian artery. The presence of the aberrant right subclavian artery on preoperative computed tomography (CT) scan suggests NRILN; however, different types of branching locations and pathways exist. Here, we report three NRILN cases with different pathways where the vagus nerve arises more medial than usual and a review of the literature. Case 1: A 30-year-old Japanese female presented with papillary thyroid carcinoma. Preoperative CT scan revealed an aberrant right subclavian artery, and an operation was performed under suspicion of NRILN. During the operation, the vagus nerve was found to arise more medially than usual and two NRILNs originated from it at the level of the cricoid cartilage and at a more caudal position; the two NRILNs were preserved. Case 2: A 33-year-old Japanese female with a thyroid nodule of increased size underwent surgery. Preoperative CT scan revealed an aberrant right subclavian artery, which suggested NRILN. During the operation, the vagus nerve was identified to run more medially than usual and NRILN was found to originate at the level of the cricoid cartilage; NRILN was preserved. Case 3: A 78-year-old Japanese female underwent an operation with a diagnosis of papillary thyroid carcinoma. Preoperative CT scan showed an aberrant right subclavian artery. During the operation, NRILN was found to originate from the vagus nerve at the level of the lower pole of the thyroid gland, and the vagus nerve ran medial to the common carotid artery at the caudal level.

A 57-year-old Chinese male patient presented with Standford type A aortic dissection with an aberrant right subclavian artery (ARSA). At operation, the ascending aorta was replaced by a mono–branch vascular prosthesis with the branch bypassing to the ARSA; the triple-branched stent graft was inserted into the true lumen of the arch and proximal descending aorta (covering the origin of the ARSA) with each sidearm graft being positioned into the aortic branches; and then its proximal end was sutured to mono–branched vascular prosthesis. Follow-up computed tomography angiography showed false lumen of the dissection disappeared with satisfactory position of the triple-branched stent graft.

An aberrant right subclavian artery arising from the descending thoracic aorta, distal to the left subclavian artery, may be associated with an outpouching at its origin, the “diverticulum of Kommerell” [1 -4]. This diverticulum is usually asymptomatic and is most often an incidental finding. It may mimic more serious disease such as thoracic aortic aneurysm, dissection, or aortic tear with mediastinal hematoma. This becomes especially important in certain clinical situations

Sir .—I was surprised to read the implication of the article by Martin and associates 1 that there was any question about the occurrence of this clinical syndrome in childhood! Their statement that "Dysphagia lusorum has been reported not to occur in children" flies directly in the face of the original report of dysphagia lusoria by Bayford 2 before the Medical Society of London in 1787. This is an account of a teenaged girl who had had such severe swallowing difficulty due to her aberrant right subclavian artery that she ultimately was said to have died of starvation! Throughout childhood she described her symptom complex as though a "wolf was grabbing at the morsel of food as she attempted to swallow it and she was unable to get the food into her stomach." This is a very dramatically told story of a child and subsequent teenager with dysphagia lusoria.