ADULT PRESENTATION OF RIGHT-DOMINANT DOUBLE AORTIC ARCH WITH TRACHEOESOPHAGEAL COMPRESSION

Abstract

Introduction: Double aortic arch (DAA) is a rare congenital vascular ring anomaly resulting from the persistence of both fourth embryonic aortic arches, creating a complete encirclement of the trachea and esophagus. It is most frequently diagnosed in infancy when symptoms of airway or esophageal compression are pronounced. Adult presentation is uncommon and may manifest as progressive dysphagia or respiratory symptoms.

Case Presentation: We report the case of a 62-year-old male with a 3-month history of progressive dysphagia to solids. Initial esophagography demonstrated smooth, well-circumscribed indentation of the right lateral esophageal wall with leftward displacement, suggestive of a right aortic arch. Subsequent computed tomography angiography (CTA) revealed a double aortic arch with a dominant right arch and hypoplastic left arch, forming a complete vascular ring. There was significant anterolateral tracheal compression with leftward deviation and anterior displacement of the esophagus.

Conclusion: This case underscores that DAA, although typically diagnosed in childhood, can remain asymptomatic until late adulthood. CTA with three-dimensional reconstruction is the diagnostic modality of choice, providing essential anatomical detail for diagnosis and surgical planning in symptomatic adult patients.