Rings and Slings:
A vascular ing is an aortic arch abnormality in which the trachea and
esophagus are surrounded by vascular structures . Vascular rings are uncommon
anomalies (less than 1% of all congenital cardiac defects) . Complete (symptomatic) rings:
1- Double aortic arch and variants-
a double aortic accounts for 50-60% of vascular rings .
2- Right aortic
arch with aberrant left subclavian and a left liagmentum arteriosum- this is the
second most common vascular ring (accounting for 12-25% of cases .
3- Circumflex aorta with persistant ductus (left aortic arch with a
right-sided descending aorta): The aorta normally descends
on the same side as the arch. In a circumflex aorta, the aorta descends
on the side opposite the arch. Thus, the aorta must cross posterior to
the trachea and esophagus to reach the opposite side- this will create
a posterior esophageal impression on barium swallow. These patients are
generally asymptomatic, but if there is a persistent ductus, this lesion
may also produce a complete ring and be symptomatic.
4- Right aortic arch with mirror image branching and a retroesophageal left
ligamentum arteriosum .
5- Pulmonary sling (Aberrant left pulmonary artery)
In one study, at least one abnormality could be detected on the chest
radiographs in all children with a symptomatic vascular ring. Therefore,
a normal PA and lateral chest radiograph is evidence against the presence
of a vascular ring in symptomatic children.
(1) Radiology 1997; 203: 423-426
(2) AJR 2005; Schlesinger AE, et al. Incomplete double aortic arch with
atresia of the distal left arch: distinctive imaging appearance. 184: 1634-1639
(3) Radiographics 2010; Kimura-Hayama ET, et
al. Uncommon congenital and acquired aortic diseases: role of multidetector CT
angiography. 30: 79-98