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Aberrant Subclavian Arteries

Cross-Sectional Imaging Findings in Infants and Children Referred for Evaluation of Extrinsic Airway Compression

Lane F. Donnelly1, Robert J. Fleck1,2, Preeyacha Pacharn1,3, Matthew A. Ziegler1, Bradley L. Fricke1 and Robin T. Cotton4

1 Department of Radiology, Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229-3039.
2 Present address: Department of Radiology, Naval Medical Center, San Diego, CA 92134-1204.
3 Present address: Department of Radiology, Mahidol University, Bangkok, Thailand 10700.
4 Division of Otolaryngology, Children's Hospital Medical Center, Cincinnati, OH 45229.



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  		Fig. 1A. —Right aortic arch with aberrant left subclavian artery causing airway obstruction in 22-month-old girl. Axial T1-weighted MR image shows right aortic arch (A). Aberrant left subclavian artery (arrowheads) is larger at its origin than more distally, consistent with Kommerell's diverticulum. Trachea (arrow) is severely compressed at this level.

 


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  		Fig. 1B. —Right aortic arch with aberrant left subclavian artery causing airway obstruction in 22-month-old girl. Endoscopic image at same level as A shows extrinsic posterior compression (arrows) of trachea.

 


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  		Fig. 1C. —Right aortic arch with aberrant left subclavian artery causing airway obstruction in 22-month-old girl. Axial T1-weighted MR image shows compression of carina and proximal bilateral main bronchi (arrows) associated with midline descending aorta (D).

 


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  		Fig. 1D. —Right aortic arch with aberrant left subclavian artery causing airway obstruction in 22-month-old girl. Endoscopic image at same level as C shows extrinsic compression of carina and main bronchi.

 


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  		Fig. 2A. —Right aortic arch with aberrant left subclavian artery causing airway obstruction in 1-year-old boy. Axial T1-weighted MR image shows aberrant left subclavian artery with mild compression of trachea (arrow). Proximal subclavian artery is dilated consistent with Kommerell's diverticulum (arrowhead).

 


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  		Fig. 2B. —Right aortic arch with aberrant left subclavian artery causing airway obstruction in 1-year-old boy. Axial T1-weighted MR image at more inferior level than A shows compression of carina (arrows) associated with midline descending aorta (D). Degree of compression at level of midline descending aorta is more severe than that at level of Kommerell's diverticulum.

 


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  		Fig. 3A. —Right aortic arch with aberrant left subclavian artery causing airway obstruction in 11-month-old male infant. CT image through upper airway shows compression of trachea (arrow) at level of arch (A) and aberrant left subclavian artery (arrowhead). Aberrant subclavian artery is greater in diameter at its origin that it is more distally, consistent with Kommerell's diverticulum (not shown).

 


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  		Fig. 3B. —Right aortic arch with aberrant left subclavian artery causing airway obstruction in 11-month-old male infant. CT image at level of lower airway shows compression of carina and proximal left main bronchus (arrow) associated with midline descending aorta (D).

 


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  		Fig. 4A. —Left aortic arch with aberrant right subclavian artery causing airway compression in 2-year-old girl. Axial T1-weighted MR image shows left aortic arch (A) and origin of aberrant right subclavian artery (arrowhead). Trachea (arrow) is compressed.

 


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  		Fig. 4B. —Left aortic arch with aberrant right subclavian artery causing airway compression in 2-year-old girl. Axial T1-weighted MR image shows most marked compression of trachea (arrow) at level of aberrant right subclavian artery (arrowhead).

 


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  		Fig. 4C. —Left aortic arch with aberrant right subclavian artery causing airway compression in 2-year-old girl. Endoscopic image at same level as A shows posterior extrinsic compression (arrows) of trachea by aberrant right subclavian artery.

 

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