Right Aortic Arch Versus Mediastinal Tumors and Densities: Diagnostic Problems

¹ The Bedford Chest Clinic of the Bureau of Tuberculosis, New York City, Department of Health.

It is of importance to recognize a right aortic arch not only for the occasional symptoms which may be produced by it, but more so, to differentiate it from mediastinal tumors and diseases of lymph nodes. The seven selected cases presented in this article, emphasize the diagnostic and differential diagnostic problems that we have encountered.

Three cases were presented in which the investigation for mediastinal and pulmonary pathology revealed a right aortic arch as an accidental finding. These three patients had somewhat dilated, elongated and tortuous aortic vessels. Their routine posterior-anterior chest films were not suggestive of right aortic arch. Two cases presented a bilateral upper mediastinal density suggestive of right aortic arch with additional mediastinal pathology. The esophagram revealed a right aortic arch in one case and excluded that diagnosis in the other. In both cases the manubrium sterni added to the diagnostic problems encountered. Positional deviations of the sternal manubrium are not infrequent. Two cases were shown with enlarged mediastinal lymph nodes simulating right aortic arch.