A 35-Year-Old with a Persistent, Frequent Cough

Differential Diagnosis

• Bronchiolitis
• Pneumonia
• Stridor
• Right aortic arch

Diagnosis

This patient was diagnosed with right aortic arch. The two most common patterns of right aortic arch are the right-sided aortic arch with mirror image branching and the right-sided aortic arch with aberrant left subclavian artery. This occurs in approximately 0.1% of the population.

Learnings/What to Look for

• Right arch with mirror image branching is associated with cyanotic congenital heart disease, including tetralogy of Fallot, truncus arteriosus, tricuspid atresia, and transposition of the great vessels
• Right arch with aberrant subclavian artery rarely produces symptoms as it usually has normal intracardiac anatomy. It is usually incidental although, rarely, it can cause esophageal and/or tracheal compression

Pearls for Urgent Care Management

• Generally, an isolated right aortic arch is a benign lesion
• Right aortic arch and left pulmonary artery anomalies may be more concerning, as well as being more difficult to identify
• Referral to cardiology is appropriate

Acknowledgment: X-ray and case presented by Experity Teleradiology (www.experityhealth.com/teleradiology).