title: Aberrant right subclavian artery encountered during debridement of T2 osteomyelitis and associated phlegmon.
abstract: BACKGROUND
  An aberrant right subclavian artery is a rare congenital abnormality of the aortic arch. The anomalous origin for the right subclavian artery arises as the last branch of the thoracic aorta. In the most common anomalous form, the right subclavian artery passes posterior to both the esophagus and trachea as it crosses midline to supply the right upper extremity. The aberrant right subclavian artery is often not symptomatic, but it can cause dysphagia.
  
  
  OBJECTIVE
  To describe a case of an aberrant right subclavian artery discovered during debridement of T2 osteomyelitis.
  
  
  METHODS
  Case report.
  
  
  METHODS
  A 49-year-old woman with diabetes was transferred to our institution with bilateral lower extremity weakness and incontinence of bowel and bladder function. Examination revealed no motor function in quadriceps, hamstrings, tibialis anterior, extensor hallucis longus, or gastrocsoleus complex of her bilateral lower extremities.
  
  
  RESULTS
  Spinal computed tomography scan showed pathologic collapse of the T2 vertebra. Magnetic resonance (MR) demonstrated an abscess and a phlegmon anterior to T2. Magnetic resonance also demonstrated spinal cord compression at the T2 vertebral level, and T2-weighted MR demonstrated the presence of spinal cord signal changes.
  
  
  CONCLUSIONS
  We report a rare case where an aberrant right subclavian artery was associated with a T2 osteomyelitis and paravertebral abscess. The intraoperative injury to this aberrant artery led to the eventual death of the patient. When planning an anterior approach to the upper thoracic region, surgeons should be aware of this anatomic variant of the subclavian artery and its associated aberrant recurrent laryngeal nerve.
authors.affiliation: Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Ave, Suite 1010, Pittsburgh, PA 15213, USA.
authors.forename: Steven W
authors.initials: SW
authors.lastname: Thorpe
authors.forename: Justin B
authors.initials: JB
authors.lastname: Hohl
authors.forename: Sebastien
authors.initials: S
authors.lastname: Gilbert
authors.forename: Chadi A
authors.initials: CA
authors.lastname: Tannoury
authors.forename: Joon Y
authors.initials: JY
authors.lastname: Lee
mesh_terms: D002481:Cellulitis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D003646:Debridement; D003680:Deglutition Disorders / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008875:Middle Aged; D010019:Osteomyelitis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D011859:Radiography; D013348:Subclavian Artery / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery; D013904:Thoracic Vertebrae / Q000601:surgery*