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(Circulation. 2000;101:459.)
© 2000 American Heart Association, Inc.

Images in Cardiovascular Medicine

Aberrant Right Subclavian Artery Mimics Aortic Dissection

Maarten Janssen, MD, PhD; Christian S. Breburda, MD, PhD; Robert Jan M. van Geuns, MD; Walter R. M. Hermans, MD, PhD; Peter Klootwijk, MD, PhD; Jos A. Bekkers, MD; Jos R. T. C. Roelandt, MD, PhD

From the Departments of Cardiology and Cardiopulmonary Surgery (J.A.B.), Erasmus University Medical Center, Rotterdam, Netherlands.

Correspondence to M. Janssen, MD, PhD, Department of Cardiology, Heartcenter Rotterdam, Zuiderziekenhuis, Groene Hilledijk 315, 3075 EA Rotterdam, Netherlands. E-mail janssen.loon@gironet.nl

A65-year-old woman complained of nocturnal dyspnea, a period of stabbing pain between the shoulder blades, and swollen ankles that had persisted for 3 days. Physical examination revealed an irregular heart rate of 120 bpm; a blood pressure of 140/90 mm Hg in both arms; basal crepitations over both lungs; a grade 3/6 diastolic murmur maximal at the left sternal border; no abnormalities of the abdominal region; normal pulses of the radial, femoral, and carotid arteries; and ankle edema. An ECG showed atrial flutter with variable ventricular response and normal QRS-T complexes. Complete blood cell count, renal and hepatic function tests, and serological studies gave normal results. Chest radiograph showed an enlarged heart, an elongated aorta, normal lungs, and thoracic kyphosis. Transthoracic echocardiography revealed a dilated ascending aorta, a dilated left ventricle with an end-diastolic diameter of 60 mm and an end-systolic diameter of 50 mm, trace mitral regurgitation, and 4+ aortic regurgitation. Angiography showed a dilated ascending aorta (70 mm), a dilated descending thoracic and abdominal aorta (50 mm), and 3+ aortic regurgitation with good left ventricular function. Selective coronary angiography failed because of the abnormal size of the aorta.

The patient was transferred to our institution for further evaluation and therapy. Suprasternal transthoracic echocardiography suggested an aortic dissection near the aortic arch (Figure 1), which could explain the episode of stabbing pain between the shoulder blades. Transesophageal echocardiography revealed normal atrial and ventricular dimensions; a dilated ascending aorta (diameter at root 70 mm), with possible dissection in the . . . [Full Text of this Article]