Vascular rings in a tertiary care center: A retrospective review of clinical presentations and interventions

Figure 3 Computed tomography angiography in vascular rings. A: Three-dimensional volume-rendered computed tomography (CT) angiography of patient 2, demonstrating a right aortic arch (RAA) with an aberrant left subclavian artery (LSA) arising from the descending aorta (DA) and coursing posterior to the esophagus. A left-sided retroesophageal ligamentum arteriosum completes the ring configuration, consistent with a complete vascular ring. In RAA with aberrant LSA from the DA, the retroesophageal course of the LSA plus a left-sided ligamentum arteriosum is the key combination that creates a complete ring; recognizing this on CT angiography (CTA) directly guides surgery toward division of the ligamentum; B: Three-dimensional volume-rendered CTA reconstruction demonstrating a left aortic arch with an aberrant right subclavian artery (ARSA) arising distally and coursing posterior to the esophagus, consistent with an incomplete vascular ring/symptomatic arch anomaly. The key diagnostic feature is the retroesophageal course of the ARSA, which can produce significant dysphagia and feeding/aspiration symptoms even without a complete ring, recognition on CTA helps guide management. CCA: Common carotid artery; LCCA: Left common carotid artery; RCCA: Right common carotid artery; ARSA: Aberrant right subclavian artery; LSA: Left subclavian artery; LAA: Left aortic arch; DA: Descending aorta.