Quiz #7: Barium Swallow Study

Question 1: Describe the findings in PA view?

Answer 1: Oblique impression in the upper esophagus (going left to right, from below upwards). However, in addition, there is a subtle compression of both side of the trachea.

Question 2: Describe the finding in Lateral view?

Answer 2: Posterior indentation of esophagus in the upper esophagus.

Question 3: What is the diagnosis?

Answer 3: Anomalous origin of right subclavian artery. In addition, this baby also has a possibility of double aortic arch (with patent right side arch giving off all the branches and ligamentous representation of left side arch. Left side arch is a presumption based on the the following findings: Right aortic arch with left descending aorta - associated with a Kommerell's diverticulum). See the rule in "Moss & Adams" - Vascular ring chapter by Dr. Paul Weinberg. Click here for link to a blog posting about the "rule". Briefly, the rule states that presence of 3 Ds in the opposite side from the ascending aorta, there is a vascular ring. The 3 Ds are Diverticulum, Dimple or Descending aorta.