Retroesophagial aortic arch

Right aortic arch is an uncommon anatomic anomaly, which occurs in approximately 0.05% to 0.1% of the population.¹ “Mirror-image” right aortic arch is by itself generally asymptomatic, but it is usually associated with cyanotic congenital heart disease.² In the event that a mirror-image right aortic arch is associated with a retroesophageal left ligamentum arteriosum, there is a vascular ring³ formed anteriorly by the ascending portion of the right aortic arch and the innominate artery, posteriorly by the aortic diverticulum, and laterally by the ligamentum arteriosum. This anomaly is rare, but it may be symptomatic.^2–7 We report the case of a patient who was having difficulty swallowing and persistent pulsatile upper-back pain. She had a mirror-image right aortic arch with a retroesophageal left ligamentum arteriosum, and with elongation and tortuosity of the descending thoracic aorta.