1620: RIGHT ON THE WRONG SIDE: A CASE OF RIGHT-SIDED AORTIC ARCH

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Abstract

Learning Objectives: A right-sided aortic arch is a rare congenital abnormality with a prevalence of 0.5% in the normal population and was first described 250 years ago by Fioratti and Aglietti. It results from an abnormal embryonic development with regression of the left fourth arch and persistence of the right dorsal aorta. Symptoms occur either due to compression of mediastinal structures or due to aneurysmal disease or dissection. Methods: 44 year-old male with history of hypertensive cardiomyopathy, hypertensive nephrosclerosis, and uncontrolled hypertension, presented to the ICU with acute onset of tearing chest pain and breathlessness on exertion. The mid-sternal pain was intense, radiating to the back, and alleviated by rest. The patient also reported progressive dysphagia. On physical examination he had pronounced JVD, a 2/6 mid-systolic murmur at the apex, 2+ peripheral edema, and clear breath sounds bilaterally. His initial blood pressure was 220/130 mmHg. Creatinine level was elevated at 3.23mg/dL, but electrolytes, coagulation studies, and cell blood count were normal. The troponin level was mildly increased and the EKG showed normal sinus rhythm with evidence of LVH, and t-wave inversion in aVL and V6. Wide mediastinum was evident on CXR. Non-contrast chest CT showed an aneurysmal dilatation of the aortic arch measuring 5 cm with 50% tracheal occlusion. However, a follow-up CT angiogram ruled out any pulmonary embolic disease, aortic aneurysm, or dissection, but revealed a right aortic arch. An echocardiographic evaluation disclosed an EF of 70% and RV with normal size and function. With appropriate treatment, patient's blood pressure normalized and symptoms subsided. Results: Patients with rightsided aortic arch (RAA) present with chest pain, dysphagia, back pain, and respiratory symptoms. It is the compressive nature of this anomaly on surrounding structures what causes its typical symptoms. Around 100 cases of RAA have been described. Nonetheless, given its presentation, rarity, and radiographic heterogeneity, right-sided aortic arch recognition continues to be difficult.
Original languageAmerican English
Pages (from-to)480-480
Number of pages1
JournalCritical Care Medicine
Volume44
Issue number12
DOIs
StatePublished - Dec 1 2016

Disciplines

  • Medicine and Health Sciences
  • Critical Care

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