Department of Radiology, West Los Angeles Veterans Affairs Medical Center, 11301 Wilshire Blvd., Los Angeles, CA 90073, USA; Department of Radiology, University of California Los Angeles Medical Center, 757 Westwood Blvd., Los Angeles, CA 90095, USA.
Clin Imaging. 2022 Apr;84:31-35. doi: 10.1016/j.clinimag.2022.01.001. Epub 2022 Jan 22.
Congenital aortic arch anomalies and variants have been extensively characterized in the medical literature. Proper identification of these anomalies is important when surgical or percutaneous interventions are indicated.
We present a case of a 48-year old male who presented to the emergency department with altered mental status. Magnetic resonance angiography (MRA) findings revealed an aberrant right subclavian artery (ARSA), early bifurcation of the right common carotid artery (CCA) with anomalous origin of the right vertebral artery (VA) from the right common carotid artery bifurcation, anomalous left vertebral artery originating from the aortic arch, and absent left common carotid artery with independent origins of the left external carotid artery (ECA) and internal carotid artery (ICA). No other abnormalities were identified, and the patient demonstrated no symptoms attributable to his vascular anomalies.
To our knowledge, this unique combination of anomalies has never been reported in the literature. With an understanding of embryological pathways, even exceedingly rare anomalies like this one can be explained.
先天性主动脉弓异常和变异在医学文献中已有广泛描述。当需要进行手术或经皮介入时，正确识别这些异常非常重要。
我们报告了一例 48 岁男性患者，因精神状态改变而到急诊科就诊。磁共振血管造影（MRA）检查结果显示右锁骨下动脉异常（ARSA）、右颈总动脉（CCA）早期分叉，右侧椎动脉（VA）异常起源于右颈总动脉分叉，左椎动脉异常起源于主动脉弓，左颈总动脉缺失，左侧颈外动脉（ECA）和颈内动脉（ICA）独立起源。未发现其他异常，患者无血管异常相关症状。
据我们所知，这种异常的组合在文献中从未有过报道。通过了解胚胎发育途径，即使是非常罕见的异常也可以得到解释。
