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• W2011902658 abstract "HomeCirculationVol. 109, No. 14Cervical Origin of the Subclavian Artery Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplementary MaterialsFree AccessReview ArticlePDF/EPUBCervical Origin of the Subclavian ArteryImaging of a Rare but Clinically Relevant Anomaly Gerald F. Greil, MD, Axel Kuettner, MD, Ludger Sieverding, MD, Max Schoebinger, MSc, Hans-Peter Meinzer, PhD, Ralf Rauch, MD, Jürgen F. Schaefer, MD, Claus D. Claussen, MD and Michael Hofbeck, MD Gerald F. GreilGerald F. Greil From the Department of Cardiology (G.F.G., L.S., R.R., M.H.), Children’s Hospital, University of Tuebingen, Germany; the Department of Radiology (A.K., J.F.S., C.D.C.), University of Tuebingen, Tuebingen, Germany; and the Department of Medical and Biological Informatics (M.S., H.P.M.), German Cancer Research Center, Heidelberg, Germany. Search for more papers by this author , Axel KuettnerAxel Kuettner From the Department of Cardiology (G.F.G., L.S., R.R., M.H.), Children’s Hospital, University of Tuebingen, Germany; the Department of Radiology (A.K., J.F.S., C.D.C.), University of Tuebingen, Tuebingen, Germany; and the Department of Medical and Biological Informatics (M.S., H.P.M.), German Cancer Research Center, Heidelberg, Germany. Search for more papers by this author , Ludger SieverdingLudger Sieverding From the Department of Cardiology (G.F.G., L.S., R.R., M.H.), Children’s Hospital, University of Tuebingen, Germany; the Department of Radiology (A.K., J.F.S., C.D.C.), University of Tuebingen, Tuebingen, Germany; and the Department of Medical and Biological Informatics (M.S., H.P.M.), German Cancer Research Center, Heidelberg, Germany. Search for more papers by this author , Max SchoebingerMax Schoebinger From the Department of Cardiology (G.F.G., L.S., R.R., M.H.), Children’s Hospital, University of Tuebingen, Germany; the Department of Radiology (A.K., J.F.S., C.D.C.), University of Tuebingen, Tuebingen, Germany; and the Department of Medical and Biological Informatics (M.S., H.P.M.), German Cancer Research Center, Heidelberg, Germany. Search for more papers by this author , Hans-Peter MeinzerHans-Peter Meinzer From the Department of Cardiology (G.F.G., L.S., R.R., M.H.), Children’s Hospital, University of Tuebingen, Germany; the Department of Radiology (A.K., J.F.S., C.D.C.), University of Tuebingen, Tuebingen, Germany; and the Department of Medical and Biological Informatics (M.S., H.P.M.), German Cancer Research Center, Heidelberg, Germany. Search for more papers by this author , Ralf RauchRalf Rauch From the Department of Cardiology (G.F.G., L.S., R.R., M.H.), Children’s Hospital, University of Tuebingen, Germany; the Department of Radiology (A.K., J.F.S., C.D.C.), University of Tuebingen, Tuebingen, Germany; and the Department of Medical and Biological Informatics (M.S., H.P.M.), German Cancer Research Center, Heidelberg, Germany. Search for more papers by this author , Jürgen F. SchaeferJürgen F. Schaefer From the Department of Cardiology (G.F.G., L.S., R.R., M.H.), Children’s Hospital, University of Tuebingen, Germany; the Department of Radiology (A.K., J.F.S., C.D.C.), University of Tuebingen, Tuebingen, Germany; and the Department of Medical and Biological Informatics (M.S., H.P.M.), German Cancer Research Center, Heidelberg, Germany. Search for more papers by this author , Claus D. ClaussenClaus D. Claussen From the Department of Cardiology (G.F.G., L.S., R.R., M.H.), Children’s Hospital, University of Tuebingen, Germany; the Department of Radiology (A.K., J.F.S., C.D.C.), University of Tuebingen, Tuebingen, Germany; and the Department of Medical and Biological Informatics (M.S., H.P.M.), German Cancer Research Center, Heidelberg, Germany. Search for more papers by this author and Michael HofbeckMichael Hofbeck From the Department of Cardiology (G.F.G., L.S., R.R., M.H.), Children’s Hospital, University of Tuebingen, Germany; the Department of Radiology (A.K., J.F.S., C.D.C.), University of Tuebingen, Tuebingen, Germany; and the Department of Medical and Biological Informatics (M.S., H.P.M.), German Cancer Research Center, Heidelberg, Germany. Search for more papers by this author Originally published13 Apr 2004https://doi.org/10.1161/01.CIR.0000121564.12555.8BCirculation. 2004;109:e177–e178A 4-year-old boy was referred to our hospital for further treatment of pulmonary atresia (Fallot type), multiple systemic to pulmonary collateral arteries, and hypoplastic central pulmonary arteries. Echocardiography revealed cervical origin of the right subclavian artery, which originated close to the bifurcation of the internal and external carotid arteries (Figure 1, Movie I, and Movie II). The anomaly of the subclavian artery was confirmed with cardiac catheterization (Figure 2A, Movie III). In addition, the boy had dysmorphic features of conotruncal anomaly facies syndrome, and monosomy 22q11 was confirmed by cytogenetic testing. To improve antegrade perfusion of the hypoplastic central pulmonary arteries, the patient underwent creation of a central aortopulmonary shunt followed by interventional coil occlusion of a large collateral artery from the descending aorta. The postoperative course was complicated by formation of a seroma of the polytetrafluoroethylene shunt, diagnosed by computed tomography (CT) of the thorax. Using a 16 detector CT scanner (Sensation 16, Siemens AG), a complete 3-dimensional data set of the neck, thorax, and upper abdomen was acquired in 10 seconds with nearly isotropic voxels (0.5×0.5×0.6 mm) using a single injection of 17 mL of contrast agent (Imeron 400) in a peripheral vein. The CT scan revealed the seroma, and 3-dimensional reconstruction demonstrated clearly the anomaly of the right subclavian artery (Figure 2B, Movie IV). After surgical revision of the seroma and balloon dilatation of a right pulmonary artery stenosis, the patient made an uneventful recovery. According to the literature, cervical origin of the subclavian artery is highly specific for 22q11 syndromes as demonstrated in this patient. Download figureDownload PowerPointFigure 1. Color-Doppler echocardiography (longitudinal section of the right neck) demonstrates cervical origin of the right subclavian artery (RSA) from the right common carotid artery (RCCA) in proximity to the bifurcation of the external (ECA) and internal (ICA) carotid arteries (A). A slightly inferior position of the transducer shows the parallel course of the RSA and RCCA in the lower neck (B). A indicates anterior; P, posterior; S, superior; and I, inferior.Download figureDownload PowerPointFigure 2. The angiogram (A) and a 3-dimensional surface reconstruction of the aorta with the great arteries based on a multidetector-row computed tomographic (16 detector) data set (B) are shown. The first right (RC) and left costa (LC) demonstrate in combination with the right (RCL) and left clavicle (LCL) the cervical origin of the right subclavian artery (arrow). Ao indicates aorta; LSA, left subclavian artery. Other abbreviations as in Figure 1.Movies I through IV are available in the online-only Data Supplement at http://www.circulationaha.org.The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke’s Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.The multidetector-row CT is partly supported by Siemens Medical Systems.FootnotesCorrespondence to Gerald F. Greil, MD, Department of Cardiology, Children’s Hospital, University of Tuebingen, Hoppe-Seyler-Strasse 3, 72076 Tuebingen, Germany. E-mail [email protected] Previous Back to top Next FiguresReferencesRelatedDetailsCited By Pandey N, Bhambri K and Kumar S (2020) Cervical origin of right subclavian artery associated with tetralogy of Fallot, Journal of Cardiac Surgery, 10.1111/jocs.14789, 35:8, (2037-2038), Online publication date: 1-Aug-2020. Machado R, Moubayed S, Khorsandi A and Urken M (2016) The importance of recognizing a cervical origin of the right subclavian artery, The Laryngoscope, 10.1002/lary.25991, 126:11, (2497-2499), Online publication date: 1-Nov-2016. Greil G, Wolf I, Kuettner A, Fenchel M, Miller S, Martirosian P, Schick F, Oppitz M, Meinzer H and Sieverding L (2007) Stereolithographic reproduction of complex cardiac morphology based on high spatial resolution imaging, Clinical Research in Cardiology, 10.1007/s00392-007-0482-3, 96:3, (176-185), Online publication date: 1-Mar-2007. Greil G, Schoebinger M, Kuettner A, Schaefer J, Dammann F, Claussen C, Hofbeck M, Meinzer H and Sieverding L (2006) Imaging of aortopulmonary collateral arteries with high-resolution multidetector CT, Pediatric Radiology, 10.1007/s00247-006-0143-0, 36:6, (502-509), Online publication date: 1-Jun-2006. April 13, 2004Vol 109, Issue 14 Advertisement Article InformationMetrics https://doi.org/10.1161/01.CIR.0000121564.12555.8BPMID: 15078807 Originally publishedApril 13, 2004 PDF download Advertisement" @default.
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