Right aortic arch anomalies occur in 0.01 to 0.1% of the general population. Abnormalities of aortic arch branching and orientation are associated with a variety of congenital heart defects (tetralogy of Fallot and truncus arteriosus), as well as chromosomal abnormalities, such as DiGeorge syndrome (22q11 deletion). While a right aortic arch with mirror image branching of the head and neck vessels does not cause any physiologic cardiovascular effects, a right aortic arch can be associated with other congenital heart defects. A subset of right aortic arches with certain nonmirror image branching patterns of the head and neck vessels can be associated with a vascular ring. There are scenarios where the anatomic features of a right aortic are clinically relevant.