Incidental Finding: Aberrant Right Vertebral Artery

A woman underwent computed tomography of the chest as an oncologic follow-up examination. An aberrant right vertebral artery was found incidentally. This is an anatomical variant in which the right vertebral artery (1) arises as the last of four branches coming off the aortic arch (2) and not, as in the usual situation, from the right subclavian artery, which is in turn a branch of the brachiocephalic trunk. The aberrant right vertebral artery courses dorsally to the esophagus (3) and trachea (4) and upward to the transverse foramina of the cervical vertebrae. Anatomical anomalies of the vertebral arteries are found in 4.7 of the population and are more common on the left side. The anomaly described here is present in 0.04; the classically described aberrant right subclavian artery, in which this artery is the last branch coming off the aortic arch, is much more common, with an incidence of up to 2. Rarely, symptoms such as dysphagia or dyspnea arise because of compression of the neighboring structures. Our patient was asymptomatic. The entity becomes relevant in surgical or endovascular procedures on the aorta, or in esophageal procedures.

Figure 1.

contrast-enhanced computed tomography, coronary MIP reconstruction, with right vertebral artery arising from the aortic arch; 1. right vertebral artery; 2. aortic arch; 3. esophagus; 4. trachea; 5. pulmonary artery

Figure 2.

contrast-enhanced computed tomography, axial MIP reconstruction, showing the right vertebral artery arising from the aortic arch; 1. right vertebral artery; 2. aortic arch; 3. esophagus; 4. trachea