Godlewski Janusz, Widawski Tomasz, Michalak Maciej, Kmieć Zbigniew
Department of Human Histology and Embryology, Faculty of Medical Sciences, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland.
Pol J Radiol. 2010 Oct;75(4):47-50.
The right subclavian artery, originating not from the brachiocephalic trunk but directly from the aortic arch, is a rare anatomical abnormality. 'Arteria lusoria' is the accepted name of the retroesophageal right subclavian artery. Such a vessel location, between the vertebral column and the esophagus, determines its course to the right. This defect may be asymptomatic, found during autopsy or coincidentally during diagnostic procedures. However, it may also be symptomatic. The course of this major blood vessel in the limited anatomical space may cause symptoms of mediastinal organ compression. The aim of this paper was to present two cases of abnormal anatomical course of the right subclavian artery and its aneurismal dilation. In this study, CT scans of the saccular aneurysm of the retroesophageal right subclavian artery were used: of a male patient diagnosed at Euromedic Diagnostics in Olsztyn and of a female patient, from the resources of the Radiological Dept. at MSWiA Hospital in Olsztyn
An 85-year-old female was admitted to Hospital ER for congestive heart failure decompensation. Her chest X-ray revealed a round mass in the upper right mediastinum. Chest CT confirmed the presence of a saccular aneurysm of the lusory artery, 6.5 cm in diameter, partially filled with thrombotic material. The patient died in hospital from myocardial infarction that was not related to the aneurysm. A 61-year-old male patient had a chest X-ray which showed a round opacity on the apex of the right lung. The diagnostic process comprised also chest computed tomography. The examination showed an anomalous origin of the right subclavian artery, with aneurysmal dilation and compression of the oesophagus and of the trachea. An intraluminal thrombus was found. The patient remained under observation till the next CT examination, 6 months later.
The presented rare cases of arteria lusoria aneurysm are not only casuistic reports. They also show the value of modern MDCT diagnostics. Multi detector CT examinations allow for a proper evaluation of the vascular anomalies in mediastinum. The analysis of vascular pathologies and accompanying compression of adjacent organs makes further treatment possible.
右锁骨下动脉并非起源于头臂干，而是直接发自主动脉弓，这是一种罕见的解剖学异常。“迷走动脉”是食管后右锁骨下动脉的公认名称。这样的血管位置，位于脊柱和食管之间，决定了其向右走行。这种缺陷可能无症状，在尸检时发现或在诊断过程中偶然发现。然而，它也可能有症状。这条主要血管在有限的解剖空间内走行可能导致纵隔器官受压症状。本文的目的是介绍两例右锁骨下动脉解剖走行异常及其动脉瘤样扩张的病例。在本研究中，使用了食管后右锁骨下动脉囊状动脉瘤的CT扫描：一例为在奥尔什丁的Euromedic诊断中心确诊的男性患者，另一例为来自奥尔什丁医科大学附属医学科学院医院放射科资料中的女性患者。
一名85岁女性因充血性心力衰竭失代偿入住医院急诊室。她的胸部X线片显示右上纵隔有一个圆形肿块。胸部CT证实存在迷走动脉囊状动脉瘤，直径6.5厘米，部分充满血栓物质。患者在医院死于与动脉瘤无关的心肌梗死。一名61岁男性患者的胸部X线片显示右肺尖有一个圆形不透光区。诊断过程还包括胸部计算机断层扫描。检查显示右锁骨下动脉起源异常，伴有动脉瘤样扩张以及食管和气管受压。发现腔内血栓。患者接受观察直至6个月后的下一次CT检查。
所呈现的罕见的迷走动脉动脉瘤病例不仅是个案报告。它们还显示了现代MDCT诊断的价值。多探测器CT检查能够对纵隔血管异常进行恰当评估。对血管病变及相邻器官伴随受压情况的分析使进一步治疗成为可能。
