* From the Department of Radiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, Holland. 438 JUNE, 1966 ABERRANT RIGHT SUBCLAVIAN ARTERY* CLINICAL AND ROENTGENOLOGIC ASPECTS By ADRIANUS C. KLINKHAMER AMSTERDAM, HOLLAND N ABERRANT right subclavian an- tery arises as the last brachiocephalic branch of the aorta. It crosses the medi- astinum obliquely from below and the left upward and to the right, reaching the right halfof the body (Fig. I, ii and B). This paper is based on a series of o cases in which an aberrant right subclavian artery was diagnosed roentgenologically. The literature has been reviewed from 1763 to 1962. From 76 publications, 292 necropsy and surgical cases have been collected. Publications in which the origin of the other brachiocephalic branches was not described have been excluded. Three personal observations were verified at surgery and are added. The purposes of the author is: (i) To show that an aberrant right subclavian artery occasionally is of real clinical signifi- cance. It can produce tracheo-esophageal compression in the same way that vascular rings do. (2) To provide an answer to the question of why and when an aberrant right subclavian artery gives rise to clinical manifestations. In our opinion, it is im- portant to emphasize these points, since it was recently stated by Beabout et al.4 that: “The role an aberrant right subclavian artery has in the production of dysphagia in adults or feeding problems and other symptoms in infancy is greatly overrated. It is doubtful that this isolated anomaly ever produces significant dysphagia.” (,) To stress some roentgenologic aspects from the diagnostic point of view. ANATOMIC ASPECTS In most instances, the aberrant right subclavian artery stems from the dorsal margin of the aortic arch, its origin being between the bend of the top of the arch and the point where the arch lies against the vertebral column.22” In a few cases, the aberrant artery originates from the descending aorta.22’2’26 The proximal part of the artery is generally greater in diam- eter than the distal part.1#{176}’22’23” In nearl- all cases, the aberrant right subclavian artery passes through the mediastinum behind the esophagus; on very rare occa- sions, it passes between the esophagus and trachea.3’5 Publications describing a pre- tracheal course of the aberrant vessel are not very convincing.4’2” In 8 of the 295 cases (29 per cent) col- lected from the literature and from personal observation, the aberrant right subclavian artery was found to be associated with a common origin of the right and left carotid arteries, the bicarotid truncus. In 31 cases ( 10 per cent), the 2 carotid arteries were situated closer to each other than normally, although they were still separated. In 179 cases (6o per cent), a normal origin of the carotid arteries was reported. In our opin- ion, it is this abnormal origin of the carotid arteries, combined with the aberrant right subclavian artery, that provides an ex- planation for the clinical manifestations produced by this aberrant vessel (see clini- cal aspects). CLINICAL ASPECTS The term “dysphagia lusoria” or diffi- culty in swallowing due to a trick of nature (aberrant artery) was introduced by Bay- ford3 in 1787. Hamburger2#{176} and Hyrtl24 were among the first to deny a relationship between dysphagia and an aberrant right subclavian artery. Hamburger proposed to change the term of dvsphagia lusonia to “dysphagia illusonia.” In the literature of more recent date, however, dysphagia due Downloaded from www.ajronline.org by 171.243.65.178 on 05/12/23 from IP address 171.243.65.178. Copyright ARRS. For personal use only; all rights reserved
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