Right aortic arch with mirror image branching (RAMI) is a rare congenital defect of the aorta. The exact incidence of RAMI in the general population is unclear. In RAMI the first branch arising from the arch is the left innominate artery, followed by the right carotid artery and right subclavian arteries. We report a case of an adult female patient with RAMI discovered as an incidental finding during radiological investigations for suspected pulmonary embolism in emergency department. No other congenital malformations were reported. It is important to recognize congenital variants of the aortic arch, as they can have relevant implications for patients' prognosis and management. Therefore, being aware of these conditions is key to avoid any mistakes or surgical and endovascular complications.
Keywords: ALSA, Aberrant Left Subclavian Artery; CHD, Congenital Heart Disease; CT, Computed Tomography; Congenital vascular anomalies; Incidental finding; LCCA, Left Common Carotid artery; LIA, Left Innominate Artery; LSA, Left Subclavian Artery; MR, Magnetic Resonance; RAA, Right Aortic Arch; RAMI; RAMI, Right aortic arch with mirror image branching; RCCA, Right Common Carotid artery; RSA, Right Subclavian Artery; Right aortic arch.