A 2.5 year old female with a history of asthma presents for fluoroscopic evaluation of an abnormality noted on PA and lateral chest radiographs obtained during an episode of wheezing.
Normal cardiopulmonary exam.
PA and lateral chest radiographs show a right-sided aortic arch and descending aorta and are otherwise unremarkable.
The frontal fluoroscopic image obtained during a barium swallow shows absence of the normal left-sided esophageal impression (i.e., absence of a normal left-sided aortic arch) and an abnormal impression on the right side of the esophagus just superior to the normal impression of the mainstem bronchus; this finding is consistent with a right aortic arch.
A lateral fluoroscopic image shows an indentation on the posterior wall of the esophagus and a more subtle indentation on the anterior wall of the trachea at a level just below the esophageal impression; these findings are consistent with a right aortic arch and an aberrant left subclavian artery.
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