Diagnosis

The PA view of the chest is unremarkable although a right sided aorta can be suspected here. The lateral view of the chest demonstrates a very narrow tracheal air column which is also bent suggesting extrinsic compression of the trachea. The lateral neck is unremarkable.

This esophagram demonstrates extrinsic compression of the esophagus consistent with a vascular ring.

Discussion

A vascular ring is a malformation of the aortic arch that results in vascular branches or major blood vessels encircling the trachea and esophagus. In nearly all instances, a right-sided aortic arch is present. In a double aortic arch (one of the most common vascular ring malformation patterns), the two arches encircle the trachea and esophagus.

See Fig. 1 - Double aortic arch

In other vascular ring malformations, vascular remnants such as the ligamentum arteriosum (formerly the ductus arteriosus) may be part of the ring encircling the trachea and esophagus. In our patient's case here, further studies delineate a right sided aortic arch with an anomalous left subclavian artery, in which the ring is completed with a left sided ductus arteriosus which closes to become the ligamentum arteriosum.

See Fig. 2 - Right-sided aorta with anomalous left subclavian artery.

Compare Fig. 1 and 2 to the normal anatomy of the aorta in its relationship to the trachea and esophagus.