Thoracic Vascular Anomalies: Insights from Embryology and Imaging

It is essential to identify vascular anomalies of the thorax because of their potential association with congenital heart diseases and genetic abnormalities. Although some patients present with symptoms early in childhood, others remain asymptomatic until adulthood. However, certain anomalies can impact the prognosis significantly and necessitate tailored treatment strategies. Moreover, understanding the embryologic origins and anatomic variations of each vasculature is paramount because many of these anomalies arise from disruptions in the developmental process and can coexist simultaneously. The authors describe the embryology, anatomy, and specific imaging findings of each vascular anomaly in two primary systems: pulmonary circulation and systemic circulation. Within the pulmonary circulation, conditions explored are unilateral absence of the pulmonary artery, aberrant pulmonary artery (pulmonary sling), partial anomalous pulmonary venous return, total anomalous pulmonary venous return, and anomalous unilateral single pulmonary vein. For systemic circulation, the anomalies reviewed are double aortic arch, aberrant right subclavian artery, right aortic arch, aberrant left subclavian artery, Kommerell diverticulum, patent ductus arteriosus, persistent left superior vena cava, and azygos continuation of the inferior vena cava. By thoroughly examining these conditions alongside their imaging findings and embryologic backgrounds, radiologists and clinicians can gain the expertise required for precise diagnosis and effective management in patients with thoracic vascular anomalies. ^©RSNA, 2025 Supplemental material is available for this article.