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The most common historical cause is a dilated left atrium due to mitral stenosis, but other causes, including pulmonary hypertension, thoracic aortic aneurysms and aberrant subclavian artery syndrome have been reported.
Aberrant subclavian artery, or aberrant subclavian artery syndrome, refers to a rare anatomical variant of the origin of the right or left subclavian artery.
Aberrant subclavian artery; with regression of the right aortic arch 4 and the right dorsal aorta, the right subclavian artery has an abnormal origin on the left side, just below the left subclavian artery.