Right Aortic Arch with Bicarotid Trunk and Aberrant Left Subclavian Artery

Presence of bicarotid trunk has been previously reported in association with aberrant right subclavian artery (SCA) with no known in human description of bicarotid trunk in association with aberrant left SCA. We, hereby, describe one such rare aortic arch pattern highlighting the association of bicarotid trunk with aberrant left SCA and direct vertebral artery origin from the right aortic arch leading to four arch vessels, which to the best of our knowledge has not been reported so far in literature. The development of aortic arch is a complex process with various congenital anomalies of aortic arch sidedness and its branching patterns. 1 Most commonly encountered pattern is left-sided aortic arch with three arch branches — brachioce-phalic artery that further gives rise to right common carotid artery (CCA) and right SCA, left CCA, and the left SCA. This case describes a rare right aortic arch branching pattern with bicarotid trunk, aberrant left SCA, and direct origin of right vertebral artery from the aortic arch. A 7-month-old male infant patient with failure to thrive, suck-rest-suck cycles, and no cyanosis underwent computed tomography (CT) angiography in view of suspected congenital heart disease (CHD) on clinical grounds and echocardiog-raphy showing large ventricular septal defect (VSD) with echo dropout between aorta and pulmonary artery. CT angiography