Case report: Incidental finding of a duplicated right vertebral artery in a 17-year-old female with suspected systemic lupus erythematosus

We present the case of a 17-year-old female with suspected systemic lupus erythematosus (SLE), receiving prednisolone and hydroxychloroquine, who was evaluated for a difference in blood pressure between the upper extremities and an elevated erythrocyte sedimentation rate (ESR). CT angiography (CTA) of the cervical vessels, performed because of clinical suspicion of vasculitis, incidentally demonstrated duplication of the right vertebral artery (VA), with both limbs originating from the right subclavian artery. The medial limb coursed posterior to the common carotid artery and anterolateral to the vertebral transverse foramen. No stenosis, occlusion, aneurysm, dissection, or other associated vascular abnormality was identified. The patient had no neurological symptoms attributable to the vascular variant. Although vertebral artery duplication is a rare congenital vascular anomaly, its identification in a young patient with suspected SLE undergoing evaluation for possible vasculitis represents an unusual clinical context. Recognition of this variant on CTA is important because its anomalous course may have implications for future cervical spine, vascular, or neurointerventional procedures. This case emphasizes the importance of careful evaluation of vertebral artery anatomy and accurate differentiation of congenital vascular variants from acquired vascular abnormalities.