An adult male underwent chest radiography for a health check-up. This disclosed both thoracic vascular anomalies and a small nodular shadow in the left side of the superior mediastinum. Axial MRI and three-dimensional volume-rendering MR angiography revealed both a double aortic arch with left atretic arch proximal to the left common carotid artery (subtype 4), and also tapering and aneurysm of the left arch distal to the left subclavian artery. To the authors' knowledge, this report describes the first case of subtype 4 of atretic double arch with left arch atresia. Such thoracic vascular anomalies have been a theoretical possibility, but no cases have been reported to date.
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