A retroesophageal right
subclavian artery may cause compression of the esophagus similar to PRAA in
a barium esophagram. This abnormality occurs when the right 7th intersegmental, being pulled forward along the dorsal aorta, fails to reach
the right 4th arch before the latter separates from the dorsal aorta.
The surgeon enters the thorax expecting to find a typical
vascular ring and discovers the aortic arch on the left side along with the
left ligamentum arteriosum. Further dissection reveals the right
subclavian artery arising on the dorsal aorta and crossing over the esophagus.