A Rare Vascular Ring Malformation Formed by Right Aortic Arch With Mirror Image Branching Causing Dysphagia: Case...

A right-sided aortic arch, a congenital anomaly of the aortic arch, was initially described by Fioratti and Aglietti in 1963. This condition, associated with formation of a vascular ring, can constrict mediastinal organs such as the trachea and esophagus. We present a case of a 42 year old male with the history of intermittent dysphagia and mild retrosternal discomfort for 6 months. The contrast-enhanced CT scan revealed a mirror-image branching pattern of the aortic arch on the right side. A vascular ring was formed and a 1.20 cm Kommerell diverticulum was found behind the esophagus. The diverticulum was small and, therefore, no surgery was carried out. The patient was managed in a conservative manner and at 3 months of follow-up, he reported an improvement in the symptoms. In this case, the diagnostic approach has played a crucial role in identifying the cause of the difficulty in swallowing in this patient. The initial examination, a mere esophagram, gives a hint of early diagnosis; that is, a smooth depression on the posterior wall of the esophagus and a significant constriction of the lumen caliber. CT scan and endoscopy confirm the presence of a pulsating external compression and the absence of primary esophageal disease. Since this patient does not have severe and progressive symptoms, there is minimal or no risk of aneurysm or dissection caused by Kommerell diverticulum. This case highlights the value of clinical suspicion of rare congenital diseases and comprehensive imaging and conservative management to achieve favorable outcomes in patients with dysphagia due to vascular ring malformation in resource-limited countries.