This is a case of a 23-year-oldpregnant female at 26 weeks gestational age who presented with shortness of breath. The patient reported brief, self-resolving episodes of shortness of breath and chest tightness every other day for the past 2-3 weeks. The symptoms were worse when laying supine. She remembered having similar episodes when she was a child between the ages of 9 to 12 and several more episodes throughout her adult life. She also reported symptoms of heartburn and mild intermittent dysphagia to solidsthat have persisted since childhood. The symptoms progressively worsened with the progression of the patient's pregnancy. The patient reported a family history of hypertension and diabetes in her mother and heart disease in her father. She denied any history of smoking, alcohol intake or illicit substance use. She reported that she lives with her parents and doesn't communicate with the father of her child. She had poor follow up with her obstetrician and missed multiple appointments. Her only medication were Ranitidine 150 mg once daily for occasional dysphagia and prenatal vitamins.
Physical examination revealed a blood pressure of 120/75 mm Hg with a pulse rate of 75. Neck exam revealed no signs of jugular venous distension (JVD). Pulmonary and cardiovascular exam were unremarkable. Laboratory work-up was unremarkable as well.
A Computed tomography with angiography (CTA) exam ruled out pulmonary embolism (PE). On close observation, a right aortic arch with aberrant left subclavian artery was incidentally discovered [Figure 1]. There was mild right-sided tracheal compression by Kommerell's diverticulum.
Over the next few days the patient's symptoms improved, and she was discharged with close follow up with vascular surgery, gastroenterology and pulmonary clinics. Given these findings, the patient was instructed to avoid exertion, follow up with gastroenterology for a barium contrast esophagogram to detect any esophageal compression, and follow up with vascular surgery for a possible surgical intervention after the delivery. Unfortunately following this admission, the patient was lost to follow-up.