Right-sided aortic arch with aberrant left subclavian artery and hearing loss in patient with abnormal cardiomediastinal contours in routine chest X-ray.

Abstract

Although the development of technologically advanced imaging techniques has progressively reduced the use of chest X-ray in clinical practice, it is still an invaluable tool to evaluate different diseases of the respiratory and cardiovascular systems. We are presenting a case of a 55-year-old male with arterial hypertension, severe mixed hearing loss who was referred to an internal medicine ward due to abnormal mediastinal and cardiac contours observed in a routine chest X-ray. The finding was linked to an anomalous aortic course what was confirmed within transthoracic echocardiography. The computed tomography angiography of the whole aorta revealed the right sided aortic arch (RSAA) with four large arteries arising from the aortic arch, including the aberrant left subclavian artery compressing the esophagus causing though no symptoms. Since RSAA might be associated with other cardiovascular diseases and genetic disorders including 22q11.2 deletion syndrome, we have conducted a complex diagnostics which showed additionally a decreased level of lymphocytes. The patient did not consent to genetic diagnostics and was qualified for conservative treatment of his disorders. In conclusion, a plain chest radiograph with the assessment of heart silhouette must not be neglected in cardiologic diagnostics. The identification of even asymptomatic aortic anatomic variant should be followed by the whole aorta angiography and a detailed assessment of the patient. RSAA bears potential risk of tracheostomy bleeding, unforeseen problems in transradial coronary procedures and potential problems during thyroid surgery, also because of abnormal recurrent laryngeal nerves’ course.