Endobronchial ultrasound in a patient with right aortic arch

A right-sided aortic arch (RAA) is a rare anomaly of the cardiovascular system, presenting in only 0.1% of the population. In some reported cases, RAA is accompanied by another cyanotic vascular anomaly such as tetralogy of Fallot, and patients with such anomalies are usually diagnosed in fetal life or early childhood. Most patients are asymptomatic if the RAA presents individually.

We report the case of a 27-year-old African American man who presented to urgent care with 3 weeks of progressive dry cough with mild shortness of breath, low-grade fevers, and night sweats. He was not on any medication. Radiographic examination of the chest showed a right paratracheal mass displacing the trachea to the left, suggesting a vascular anomaly with mediastinal adenopathy. Radiographic images suggested either lymphoma or chronic granulomatous disease, and the patient underwent endobronchial ultrasound bronchoscopy under general anesthesia. He was ultimately diagnosed with sarcoidosis.

Endobronchial ultrasound with real-time guided transbronchial needle aspiration played a significant role in obtaining a sufficient tissue sample to make the diagnosis with minimal side effects, despite the presence of the RAA anomaly.