case_images: PMC4782472_01
case_images: Transthoracic echocardiogram in suprasternal long axis view shows left-sided aortic arch with normal branching pattern of neck vessels. A vascular channel (*) originates unequivocally proximal to the origin of the right brachiocephalic artery and terminates at the pulmonary artery confluence. The pulmonary end of this vascular channel is constricted with turbulence seen on color Doppler interrogation (right panel). AAo = Ascending aorta, BCA = Brachiocephalic artery, CCA = Common carotid artery, RPA = Right pulmonary artery, SCA = Subclavian artery
case_images: APC-9-62-g001.jpg
case_images: PMC4782472_01_APC-9-62-g001.jpg
case_images: F1
case_images: A vascular channel arising from the ascending aorta could be traced to a termination at the confluence of the pulmonary arteries [Figure 1 and online video 1].
case_images: CT angiographic images reconstructed using volume rendering technique (VRT) in right anterior oblique view (panel A) and left posterior oblique view (panel B). The vascular channel (*) supplying the pulmonary arteries originates from the ascending aorta. The origin is unequivocally proximal to the origin of the brachiocephalic artery and it terminates into the pulmonary artery confluence at the usual sight of patent arterial duct making it very likely to represent the fifth arch artery. The narrowing at the pulmonary end is visualized in panel B. AAo = Ascending aorta, LPA = Left pulmonary artery, RPA = Right pulmonary artery, BCA = Brachiocephalic artery
case_images: APC-9-62-g002.jpg
case_images: PMC4782472_01_APC-9-62-g002.jpg
case_images: F2
case_images: Computed tomography was performed for better demonstration of the anatomy, confirming the origin of the vascular channel from the posteromedial aspect of the ascending aorta proximal to the origin of the brachiocephalic artery, and demonstrating its tortuous course to its termination at the confluence of the pulmonary arteries [Figure 2].