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Case Reports
. 2022 Oct 27;4(5):e220126.
doi: 10.1148/ryct.220126. eCollection 2022 Oct.

Isolated Right Common Carotid Artery Arising from the Right Pulmonary Artery

Erin K Romberg  1 , Jenna S Schauer  1 , Heidi Cuffee  1 , Delphine Yung  1 , Mark R Ferguson  1
Affiliations
Case Reports

Isolated Right Common Carotid Artery Arising from the Right Pulmonary Artery

Erin K Romberg et al. Radiol Cardiothorac Imaging. .

Abstract

Isolated aortic arch vessels arising anomalously from the pulmonary arterial system are rare congenital anomalies. Case reports of isolated arch vessels are often associated with 22q11 deletion, CHARGE syndrome, or right aortic arch. Isolation of the carotid artery may lead to cerebral steal phenomenon and ischemia or to pulmonary overcirculation. The authors report what is, to their knowledge, the first case of isolated right common carotid artery arising from the right pulmonary artery, associated with 22q11 deletion, and describe the challenging multimodality image evaluation. Keywords: Congenital, Anatomy, Carotid Arteries © RSNA, 2022.

Keywords: Anatomy; Carotid Arteries; Congenital.

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Conflict of interest statement

Disclosures of conflicts of interest: E.K.R. No relevant relationships. J.S.S. No relevant relationships. H.C. No relevant relationships. D.Y. No relevant relationships. M.R.F. No relevant relationships.

Figures

Parasternal short-axis echocardiogram in a 14-month-old boy with 22q11 deletion syndrome demonstrates abnormal continuous incoming flow (red flow at arrow) entering the right pulmonary artery (RPA) directed toward the main pulmonary artery (MPA).
Figure 1:
Parasternal short-axis echocardiogram in a 14-month-old boy with 22q11 deletion syndrome demonstrates abnormal continuous incoming flow (red flow at arrow) entering the right pulmonary artery (RPA) directed toward the main pulmonary artery (MPA).
Frontal view three-dimensional rendered image from contrast-enhanced chest CT angiography demonstrates an anomalous vessel arising from the right pulmonary artery coursing cranially out of the field of view. LPA = left pulmonary artery, RCC = right common carotid artery, RPA = right pulmonary artery.
Figure 2:
Frontal view three-dimensional rendered image from contrast-enhanced chest CT angiography demonstrates an anomalous vessel arising from the right pulmonary artery coursing cranially out of the field of view. LPA = left pulmonary artery, RCC = right common carotid artery, RPA = right pulmonary artery.
(A) Axial proton density MR image demonstrates normal configuration of the bilateral common carotid (arrows) and vertebral arteries (arrowheads). (B) Axial time-of-flight MR angiogram demonstrates normal cranial flow-related enhancement in the left common carotid artery (thick arrow) and bilateral vertebral arteries (arrowheads), with complete lack of cranial flow-related enhancement in the right common carotid artery (thin arrow). (C) Coronal maximum intensity projection time-of-flight MR venogram demonstrates normal caudal flow-related enhancement in the bilateral jugular veins (arrowheads), as well as confirming reversed caudal flow-related enhancement in the right common carotid artery (arrow).
Figure 3:
(A) Axial proton density MR image demonstrates normal configuration of the bilateral common carotid (arrows) and vertebral arteries (arrowheads). (B) Axial time-of-flight MR angiogram demonstrates normal cranial flow-related enhancement in the left common carotid artery (thick arrow) and bilateral vertebral arteries (arrowheads), with complete lack of cranial flow-related enhancement in the right common carotid artery (thin arrow). (C) Coronal maximum intensity projection time-of-flight MR venogram demonstrates normal caudal flow-related enhancement in the bilateral jugular veins (arrowheads), as well as confirming reversed caudal flow-related enhancement in the right common carotid artery (arrow).
Intraoperative frontal image following sternotomy demonstrates the isolated right common carotid artery (arrow, looped by yellow string) arising off the right pulmonary artery (arrowhead). * = ascending aorta.
Figure 4:
Intraoperative frontal image following sternotomy demonstrates the isolated right common carotid artery (arrow, looped by yellow string) arising off the right pulmonary artery (arrowhead). * = ascending aorta.
Edwards hypothetical arch model, assuming that the ductus arteriosus connects to the respective arch proximal to the subclavian arteries. Formation of the typical left aortic arch (top), a right arch with aberrant left subclavian artery (middle), and our patient’s arch configuration (bottom) with left arch, isolated right common carotid artery, and aberrant right subclavian artery. Red indicates systemic arterial structures, light blue indicates pulmonary arterial structures, dark blue indicates ductus arteriosus, and black lines indicate the absorption points. AAo = ascending aorta, DAo = descending aorta, L CC = left common carotid artery, L Sc = left subclavian artery, PA = pulmonary artery, R Bc = right brachiocephalic artery, R CC = right common carotid artery, R Sc = right subclavian artery.
Figure 5:
Edwards hypothetical arch model, assuming that the ductus arteriosus connects to the respective arch proximal to the subclavian arteries. Formation of the typical left aortic arch (top), a right arch with aberrant left subclavian artery (middle), and our patient’s arch configuration (bottom) with left arch, isolated right common carotid artery, and aberrant right subclavian artery. Red indicates systemic arterial structures, light blue indicates pulmonary arterial structures, dark blue indicates ductus arteriosus, and black lines indicate the absorption points. AAo = ascending aorta, DAo = descending aorta, L CC = left common carotid artery, L Sc = left subclavian artery, PA = pulmonary artery, R Bc = right brachiocephalic artery, R CC = right common carotid artery, R Sc = right subclavian artery.
See this image and copyright information in PMC

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