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Silent double aortic arch in an elderly patient.

A 63-year-old woman with COPD presented to our hospital with complaints of breathlessness on exertion, productive cough and weight loss. Chest X-ray showed a bright silhouette extending from the aortic knob in the right paratracheal area on the PA-view and a posterior indentation of the tracheal air column on the lateral view. No other abnormalities were observed. Further work-out consisted of a contrast enhanced CT of the chest which revealed bilateral aortic arches, both of which arising from the ascending aorta anterior to the trachea. Each arch gave origin to the common carotid artery and the subclavian artery, and joined the right posterior ward to form the descending aorta. The left arch was the larger of the two arches. The trachea and esophagus were placed in the middle of the aortic ring. No abnormal compression of the trachea or the esophagus was observed.