Abstract
The aberrant right subclavian artery (ARSA) is an abnormality of the aortic arch present in 1–2 % of the general population. However, it can be also associated with Down syndrome (DS) in up to 35% of the cases. We present a case report of an isolated aberrant right subclavian artery at 29+0 w.g. and discuss the management options. A 31-year-old gravida 1, para 0, presented at 29+0 w.g. for a routine third trimester scan. The combined first trimester screening had a low-risk result for DS. The scan revealed a viable fetus with biometry consistent with the gestational age. Isolated aberrant right subclavian artery was visualized with no other fetal structural abnormalities. The patient opted for fetal echocardiography by a pediatric cardiologist. The ARSA was not confirmed but the diagnostic criterion used was non-visualization of four vessels arising from the aortic arch in the longitudinal view. After extensive counseling, the parents opted for subsequent follow-up scans without any invasive diagnostic procedure. Echocardiography after birth confirmed the prenatal diagnosis of ARSA. Even an isolated finding, ARSA is still an indication for fetal karyotyping due to its high prevalence in DS. Demonstration of four vessels arising from the aortic arch in the longitudinal view is more easily achieved before 22 w.g. when the vessels are closer to each other, rather than in late gestation. Visualization of the aberrant right subclavian artery is easily achieved in a cross-sectional plane of the 3-vessels and trachea (3VT) view by reducing the velocities and focusing on an artery that arises from the aortic arch and runs behind the trachea and towards the right shoulder. Pulsed Doppler is used to distinguish this artery from the normal azygos vein. Aberrant right subclavian artery can be accurately diagnosed prenatally. Two-dimensional ultrasound with Color Doppler is a useful imaging modality that reliably identifies typical images at the level of the 3VT.
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