electronic-Perak Medical Journal. August 2019; Volume 1, Special Issue 2
Journal homepage: http://gids.mohe.gov.my/index.php/pmj
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CONFERENCE PROCEEDINGS
This abstract was submitted to Perak Research Conference 2019 20 August 2019
CASE OF ARTERIA LUSORIA – A RARE ANATOMICAL VARIATION
Subasker Jayaprakasam, Sazali Satari
Department of Radiology, Teluk Intan Hospital, Ministry of Health MALAYSIA
ABSTRACT
Keywords
arteria lusoria, aberrant right subclavian artery, thorax abdominal pelvis
Correspondence to:
Subasker Jayaprakasam [email protected] Back to Content Page INTRODUCTION
Arteria lusoria (AL) or aberrant right subclavian artery (ARSA) represents normal anomalies of aortic arch with an incidence around 0.5%-2%. Instead of being the first branch of the brachiocephalic artery, the subclavian artery arises on its own as the fourth branch after the left subclavian artery (from the aortic arch). Along its course, it may have variable position with the oesophagus, either posterior to the oesophagus (80%), between oesophagus and trachea (15%) or anterior to the trachea (5%). Majority of the cases are asymptomatic. This variant would be commonly missed if clinicians are not able to locate them through radio-imaging.
CASE PRESENTATION
68 years old, Malay female with endometroid adenocarcinoma, underwent CT TAP in our centre for disease surveillance.
An incidental finding of rare origin of right subclavian artery arising from the left side of aortic arch was seen. Previous CT TAP was done in 2016 and this variant was detected as well. It is retrooesophageal in course. AL is a normal anatomical variant that can be diagnosed with direct visualization from CT Thorax. In this case, the diagnosis of Arteria lusoria was derived by tracing the course of the artery in detail with direct visualization from CT thorax. The possible complications associated with AL would be dyspnea, stridor, hoarseness of voice, dysphagia lusoria or chest pain. However, in this case none of these complications were detected. Differentials may include other vascular anomalies like aberrant left pulmonary artery, right arch with aberrant left subclavian artery and double aortic arch which may show retrotracheal or retrooesophageal course as well. Those differential diagnoses were excluded in this patient. Outlining the course of the artery will differentiate AL from other vascular anomalies. The possible complications associated with AL would be Kommerell’s diverticulum. This refers to a pouch like dilatation at the origin of an aberrant right subclavian artery. For patients with retro-oesophageal course, Kommerell’s diverticulum can get compressed between the oesophagus and the vertebra. An AL may also compress the recurrent laryngeal nerve causing palsy of the nerve, which is termed Ortner’s syndrome. Other rare complications that may arise are arterioesophageal or arteriotracheal fistulae which can cause hematemesis or haemoptysis. Fortunately, these complications were not seen in our case. Treatment may not be indicated in patients who are asymptomatic. This current CT shows no evidence of complication caused by AL.
CONCLUSION
Arteria lusoria or aberrant right subclavian artery is a significant anatomical variation which has crucial importance for doctors. It’s important to diagnose, and treat the complications that may occur. Diagnosis of ARSA cannot be achieved without radio-imaging. The common method would be contrast enhanced CT Thorax which may demonstrate clearly the course of the right subclavian artery. Hopefully through this case study, doctors would be more efficient in diagnosing arteria lusoria and other aortic arch vascular anomalies through CT scan.
