Diagnosing the unexpected: double aortic arch with vascular ring in the fifth decade of life.

Abstract

A 42-year-old man without cardiovascular risk factors was referred for cardiology consultation due to atypical chest pain. He had a previous history of allergic asthma, without recent exacerbations. Coronary computed tomography (CT) angiography excluded coronary artery disease. However, the cardiac CT disclosed a double aortic arch (DAA) (Panels A–C: 3D volume-rendered CT scans). This DAA presented a co-dominant configuration, with the left subclavian (grey square) and left common carotid arteries (grey dot) arising from the left arch, and the right arch originating the right subclavian (black square) and right common carotid (black dot) arteries (Panels A and B). The anomalous conformation resulted in a complete vascular ring (Panel C), without producing compression of the trachea (asterisk, Panel D). A reduction of the endoluminal caliber of the oesophagus was noted, but the patient...