Right aortic arch with an aberrant origin of the left subclavian artery. Echocardiogram in a transverse orientation from a suprasternal notch window demonstrating the transverse aortic arch coursing to the right of the echo-bright trachea. The first branch off the arch is the left common carotid artery. It courses leftwards and superiorly into the neck, where it is positioned just medially to the left jugular vein. The second and third branches off the arch are the right common carotid and right subclavian arteries, respectively. If, as in this case, there is a right aortic arch and the first branch off the arch fails to bifurcate into the left carotid and left subclavian arteries, this finding should raise suspicion for an aberrant origin of the left subclavian artery. The aberrant left subclavian artery itself is not depicted on this imaging sweep.

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