Rare Combination of Right Aortic Arch, Aberrant Left Subclavian Artery and Absent Left Pulmonary Artery in a Boy with Tetralogy of Fallot

INTRODUCTION: Right aortic arch is associated with an aberrant subclavian artery and absence of left pulmonary artery in patients with Tetralogy of Fallot. However, the occurrence of a combination of the right aortic arch, an aberrant left subclavian artery, and an absent left pulmonary artery in a single patient is rare. Therefore, the purpose of this case report was to discuss the rare association between a right aortic arch, the absence of a left pulmonary artery, and an aberrant left subclavian artery in an 8-year-old Ethiopian boy with Tetralogy of Fallot. CASE PRESENTATION: An 8-year-old male child who presented with easy fatigability, dizziness, and intermittent difficulty in swallowing solid food over the past two years. He had grade clubbing, cyanosis of the lips, and an ejection systolic murmur at the left lower sternal border. Tetralogy of Fallot with absent left pulmonary and right aortic lesions was diagnosed using echocardiography. CT tomography revealed a detailed vascular anatomy and confirmed the diagnosis of an aberrant left subclavian artery. CONCLUSION: In the evaluation of patients with Tetralogy of Fallot, it is important to pay close attention to vascular abnormalities such as right aortic arch, aberrant left subclavian artery, and absent left pulmonary artery for not missing them.