CASE 5034 Published on 20.03.2008

Persistent Fifth Aortic arch

Section

Cardiovascular

Case Type

Clinical Cases

Authors

Shukla R, Stuart A G, Hamilton M C K

Patient

45 years, female

Clinical History
We report a case of persistent fifth aortic arch discovered incidentally in a 45 year old lady who had a single arterial trunk (Type I) with a ventricular septal defect (VSD), treated with right ventricle to pulmonary artery conduit and VSD closure.
Imaging Findings
A 45 year old woman, who was a follow up case of Truncus Arteriosus Type I and ventricular septal defect (VSD), treated with right ventricle to pulmonary artery conduit and VSD closure, was advised a rotine cardiac MRI to evaluate the conduit. No previous imaging was available for comparison. On Magnetic Resonance Angiography (MRA), there was a right sided aortic arch with mirror image branching. On the undersurface of the arch there was a short second channel separated from the main arch by a thin septum.
Discussion
Persistent fifth aortic arch is a rare congenital heart defect which was first described in 1969. In this anomaly the fourth arch is normal, giving rise to the brachiocephalic artery. The fifth arch, which normally regresses, persists to connect the ascending and descending aorta to form a channel caudal to the true arch. The resultant arch is sometimes referred to as a “double lumen arch.” This condition is commonly associated with other cardiac malformations. It is important to be familiar with the appearance of the persistent fifth arch so that it is not confused with aortic dissection.
Differential Diagnosis List
Persistent fifth aortic arch.
Final Diagnosis
Persistent fifth aortic arch.
Case information
URL: https://eurorad.org/case/5034
DOI: 10.1594/EURORAD/CASE.5034
ISSN: 1563-4086