![]() These aberrations are the result of either abnormal persistence or involution of embryonic vascular segments. Therefore, being aware of these conditions is key to avoid any mistakes or surgical and endovascular complications.ĪLSA, Aberrant Left Subclavian Artery CHD, Congenital Heart Disease CT, Computed Tomography Congenital vascular anomalies Incidental finding LCCA, Left Common Carotid artery LIA, Left Innominate Artery LSA, Left Subclavian Artery MR, Magnetic Resonance RAA, Right Aortic Arch RAMI RAMI, Right aortic arch with mirror image branching RCCA, Right Common Carotid artery RSA, Right Subclavian Artery Right aortic arch. Congenital aortic arch malformations present a large spectrum of variations and anomalies that emanate from disordered embryogenesis of branchial arches. It is important to recognize congenital variants of the aortic arch, as they can have relevant implications for patients' prognosis and management. No other congenital malformations were reported. It is unusual to have a right aortic arch with mirror-image branching of the brachiocephalic vessels and no associated congenital cardiac anomalies. right aortic archwith mirror-image branch-ingofthe majorarteries, and theposterior orright arch with anaberrant left sub-clavian artery. We report a case of an adult female patient with RAMI discovered as an incidental finding during radiological investigations for suspected pulmonary embolism in emergency department. MRI demonstrated a right-sided aortic arch with mirror image branching and a tubular structure connecting the left brachiocephalic artery to the distal pulmonary trunk (see Figure 1). In RAMI the first branch arising from the arch is the left innominate artery, followed by the right carotid artery and right subclavian arteries. The exact incidence of RAMI in the general population is unclear. Right aortic arch with a left innominate (brachiocephalic) artery with mirror image branching (RAMI) is a rare congenital anomaly, and it is unusual to diagnose it in adulthood. In RAMI the first branch arising from the arch is the left innominate artery, followed by the right carotid artery and right subclavian arteries. Right aortic arch with mirror image branching (RAMI) is a rare congenital defect of the aorta. AA, ascending aorta DA, descending aorta R SCA, right subclavian artery R CCA, right common carotid artery L CCA, left common carotid artery L SCA, left subclavian artery PA, pulmonary artery ducti arteriosi ( arrows ). The exact incidence of RAMI in the general population is unclear. Schematic based on Edwards’ hypothetical embryonic double aortic arch. Right aortic arch with mirror image branching (RAMI) is a rare congenital defect of the aorta.
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