A double aortic arch presenting in the 7th decade of life

A 64-year-old woman presented to the Vascular Outpatient department concerned about a pulsatile swelling in her right supraclavicular fossa. She had no other symptoms. A computed tomography angiogram demonstrated a double aortic arch (DAA) with the innominate artery arising from the right arch and left common carotid and subclavian arteries arising from the left arch. There were no aneurysms. A DAA accounts for 1% of congenital cardiac disease. It is the commonest form of a complete vascular ring, caused by a failure of the embryological, right, fourth pharyngeal arch to regress. Patients typically present in childhood with symptoms arising from tracheal and oesophageal compression, which frequently require surgical intervention. There is a paucity of evidence on how to manage this disease in adulthood, with only a handful of reported cases. Our patient was treated conservatively with advice about potential complications.