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Online publish-ahead-of-print 26 February 2007
Double aortic arch and left superior vena cava persistence visualized by 16-row detector
multi-slice computed tomography
Egidio Traversi1*, Giuseppe Bertoli2, and Gian Carlo Barazzoni2
1
Cardiology Department, Fondazione Salvatore Maugeri, Via Ferrata 4, 27100 Pavia, Italy; 2Radiology Department,
Salvatore Maugeri Foundation, Pavia, Italy
* Corresponding author. Tel:
þ 39 (0)382592611; fax: þ 39 (0)382592099. E-mail address: etraversi@fsm.it
A 38-year-old woman (F.N.) suffering from dysphagia underwent a
gastroduodenoscopy. An external compression of the middle
portion of the oesophagus was demonstrated. The patient then
underwent a 16-row detector multislice computed tomography
(CT) (Lightspeed 16 pro, G.E. Medical System, Milwakee, WI,
USA) with i.v. administration of iodated non-ionic contrast media
(100 mL) and ECG-gated acquisition of the images. A double
aortic arch was demonstrated (Panel A). The left carotid (LC)
artery and the left subclavian (LS) artery originate from the left
arch, whereas the right carotid (RC) artery and the right subclavian (RS) artery from the right (Panel B). This is clearly demonstrated from the endovascular view of the double arch (Panel C).
Both the subclavian ostia show a diameter slightly greater than
those of the carotid arteries. Along with this malformation, the
persistence of the left superior vena cava draining into the coronary sinus and passing anteriorly to the left pulmonary veins was
demonstrated. In Panel D, using a particular visualization of
the cardiac structures (called ‘transparency’), the relationship
between the superior vena cavae and cardiac structures is well
valuable. Volume rendering multislice CT images seem particularly
useful in complex cardiac and vascular malformations: in this case,
with a single non-invasive examination, the origin of the symptoms
was explained and a complete picture of the anatomical situation
was obtained. This aspect is a further atout of the method when
planning for a surgical approach.
Panel A. Volume rendering posterior view of the heart and the
aorta. AA, ascending aorta.
Panel B. Volume rendering lateral (left) view of the aorta. Abbreviations as given in Panel A; DA, descending aorta.
Panel C. Intravascular view (‘virtual angioscopy’) of the double aortic arch. Abbreviations as given in Panel A.
Panel D. Volume rendering posterior view of the heart. Transparency reconstruction. DA, descending aorta; IVC, inferior vena cava; PV,
pulmonary veins (grey); CS, coronary sinus; LVC, left superior vena cava; RA, right atrium; RVC, right superior vena cava (standard
colourization).
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Clinical vignette