E2049. Multimodality Evaluation of Aortic Arch Anomalies
  1. Wen Wang; UF Health Radiology - Jacksonville
  2. Sherif Elsherif; UF Health Radiology - Jacksonville
  3. Phillip Esposito; UF Health Radiology - Jacksonville
  4. Thomas Fredericks; UF Health Radiology - Jacksonville
  5. Dheeraj Gopireddy; UF Health Radiology - Jacksonville
  6. Travis Meyer; UF Health Radiology - Jacksonville
Developmental anomalies of aortic arch are frequently encountered in radiology practice. Some of these malformations are asymptomatic while others may have surgical or interventional implications. Thus, it is important to radiologists to diagnose these conditions.

Educational Goals / Teaching Points
Describe embryologic development of aortic arch and related anomalies. Illustrate radiologic appearance of aortic anomalies with focus on reformat images. Discuss medical and surgical implications of such anomalies.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
The aorta and its branching vessels arise embryonically from right and left dorsal aorta which are connected to six pair of aortic arches. Normally right dorsal aorta regresses. Double aortic arch occurs when the right dorsal aorta fails to regress. If the left dorsal aorta regresses instead then the aortic arch would be right sided. Vascular ring from double aortic arch or aberrant subclavian artery can cause compression of trachea and esophagus. Surgical repair is the mainstay of treatment for patients symptomatic from tracheal and/or esophageal compression.  Computer tomography angiogram (CTA) or magnetic resonance angiogram (MRA) is the diagnostic study of choice for preoperative evaluation to determine the location and branching pattern of aorta, aorta dominance, and extent of tracheal and/or esophageal compression. Three-dimensional (3-D) volume-rendered technique (VRT) imaging can provide better visualization. Anomalous origin of the vertebral artery may increase risk of posterior circulation cerebrovascular disease. It is important to review aortic arch anomalies prior to supra-aortic endovascular intervention to avoid complication.

Radiologists should be aware of aortic anomalies and associated findings for their clinical and surgical implications. CTA or MRA is study of choice to evaluate such anomalies. 3-D reformat imaging can provide better visualization of aortic arch anatomy and branching pattern.