Case Report Aberrant right subclavian artery encountered during debridement of T2 osteomyelitis and associated phlegmon Steven W. Thorpe, MD a , Justin B. Hohl, MD a , Sebastien Gilbert, MD b , Chadi A. Tannoury, MD c , Joon Y. Lee, MD d, * a Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Ave, Suite 1010, Pittsburgh, PA 15213, USA b Department of Surgery, Section of Foregut Surgery, Division of Thoracic Surgery, The Ottawa Hospital, University of Ottawa, 501 Smyth Ottawa, Ontario, Canada c Department of Orthopaedic Surgery, Thomas Jefferson University, 925 Chestnut St, Philadelphia, PA 19107, USA d Division of Spinal Surgery, Department of Orthopaedic Surgery, University of Pittsburgh, Kaufmann Medical Bldg, 3471 Fifth Ave, Pittsburgh, PA 15213, USA Received 15 May 2010; revised 28 August 2010; accepted 19 November 2010 Abstract BACKGROUND CONTEXT: An aberrant right subclavian artery is a rare congenital abnormal- ity 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 pos- terior 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. PURPOSE: To describe a case of an aberrant right subclavian artery discovered during debride- ment of T2 osteomyelitis. STUDY DESIGN: 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 gastro- csoleus 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 res- onance 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. Ó 2011 Elsevier Inc. All rights reserved. Keywords: Aberrant right subclavian artery; Thoracic vertebral osteomyelitis; Anterior approach to proximal thoracic spine Introduction An aberrant right subclavian artery is a rare congenital abnormality of the aortic arch in which the right subclavian artery arises as the last branch of the aortic arch and crosses the midline. Only 10% of the patients with aberrant right subclavian artery are symptomatic, often presenting with dysphagia [1–5]. The aberrant right subclavian artery has primarily been described in cardiothoracic and vascular literature. It has, to our knowledge, never been described in spine literature. The purpose of this report is to describe a complication and eventual mortality that was directly related to the presence of an aberrant right subclavian artery in a case of the debri- dement of T2 for osteomyelitis. FDA device/drug status: not applicable. Author disclosures: none. * Corresponding author. Division of Spinal Surgery, Department of Orthopaedic Surgery, University of Pittsburgh, Kaufmann Medical Bldg, 3471 Fifth Ave, Pittsburgh, PA 15213, USA. Tel.: (412) 605-3298; fax: (412) 605-3269. 1529-9430/$ - see front matter Ó 2011 Elsevier Inc. All rights reserved. doi:10.1016/j.spinee.2010.11.016 The Spine Journal 11 (2011) e6–e10