Circumflex retroesophageal right aortic arch: rare differential of mediastinal widening

Description 

A 48-year-old man presented to the outpatient department with complaints of inspiratory stridor and occasional dysphagia. Chest radiograph revealed bilateral symmetric widening of the superior mediastinum at the level of aortic arch with the descending aorta seen to the left of spine. No lateral displacement of tracheal air column was noted (figure 1A). The patient was referred to us for a CT angiography (CTA) with a provisional diagnosis of an aneurysm or a mediastinal mass. Review of CTA images revealed a right-sided aortic arch crossing the midline posterior to the trachea and the oesophagus in the upper mediastinum and further descending on the left side of spine (figure 1B–E). A Kommerell's diverticulum arising from the anterosuperior aspect of aorta, on the left side, gave rise to an aberrant left subclavian artery (LSCA). The circumflex arch was ectatic and measured 37 mm in its maximum...

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