A limited number of cases have been reported in the medical literature in which aortic dissection occurs with an aberrant right subclavian artery and a common carotid trunk. The authors report the case of a 59-year-old man who presented to the emergency department with sudden onset pain of 30 minutes duration on the right side of the buttocks. After presentation, the patient developed chest pain, which radiated to the back. Computed tomography angiogram revealed a Stanford type A aortic dissection that extended down to the bifurcation of the iliac arteries. He was also found to have an aberrant right subclavian artery with a retroesophageal tract and a common trunk of the common carotid arteries. The patient was transferred to a tertiary care center and underwent surgery for aortic arch replacement. The authors also discuss the embryologic development of these vascular abnormalities.

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