Silent Double Aortic Arch Found in an Elderly Man
A 73-year-old male was hospitalized for cerebral bleeding in his thalamus and complained of chest pain during his hospitalization. During the heart attack, the ECG showed an ST-segment depression in leads II, III, and aVF. A thulium cardiac scintigram showed an inferior redistribution, indicating the presence of coronary heart disease. The patient had a history of hypertension and hypercholesterolemia, but no history of bronchial asthma or esophageal problems. Three months later, the patient was transferred to the cardiology department and a cardiac catheterization was scheduled. A plain chest roentgenogram showed a bilateral aortic notch at the level of aortic arch, indicating possible congenital abnormalities (Figure 1). A computed tomography scan and magnetic resonance imaging revealed a double symmetric aortic arch in both the left and right sides (Figure 2 and 3⇓). The catheterization revealed a double aortic arch with advanced 3-vessel coronary artery disease. The patient underwent aortocoronary bypass surgery. The postsurgical course was uneventful and the patient was discharged (Figure 4).
Double aortic arch or aortic ring is a congenital abnormality. In most cases, this abnormality is diagnosed in childhood because of symptoms related to esophageal or tracheal obstruction, and surgical correction usually yields a good prognosis. Sporadic cases have been reported in adult patients, who are usually diagnosed after complaining of asthma-like symptoms or swallowing difficulties because of the compression of the trachea or esophagus by the abnormal aortic arches. Case reports of elderly patients are rare, especially symptom-free cases. The patient’s double aortic arch was defined accidentally when he began suffering from cerebral bleeding and his coronary heart disease became symptomatic. In this particular case, the trachea and esophagus were placed in the middle of the aortic ring without compression, because the right and left aortic arches were almost the same size and the inner space of the ring was large enough to fit them both inside.