## 1 Introduction  
Thoracic aortic pathologies, in particular aortic aneurysm and dissection, are among the main cardiovascular causes of morbidity and mortality [1]. Despite the recent decrease in deaths caused by thoracic aortic pathologies, one review by [PERSON] et al. [2] highlighted how more than 40% of such deaths occurred in patients who were not considered at high risk for these diseases and thus never examined for aortic abnormalities or overt aortic diseases. Current guidelines recommend imaging surveillance in those patients who present with cardiovascular risk factors such as hypertension or smoking and familiarity with diseases associated with aortic pathologies, such as the Marfan syndrome [3]. Importantly, along with the aforementioned well-established risk factors, arch anatomy and geometry play a pivotal role in determining the likelihood of aortic disease [4]. In particular, among aortic arch variants, we take here into consideration the so-called \"bovine\" arch, a configuration characterized by a common origin of the innominate and left carotid artery (CILCA), including the case of left carotid artery sharing a common orifice and a common trunk with the innominate artery (the latter also known as brachioccephalic trunk or brachioccephalic artery) (CILCA type 1) and the case of the left carotid artery branching off from the innominate artery (CILCA type 2) [5]. The bovine aortic arch variant has been linked to a higher incidence and relative risk of thoracic aortic diseases such as aneurysms and dissections, particularly type B aortic dissections [6; 7; 8; 9]. [PERSON] et al. [6] reported that 556 patients with thoracic aortic diseases (aneuryss, dissections, intramural hematoma, or aortic rupture) showed a significantly higher prevalence of a CILCA variant (24.6%) than that seen among 4617 historical controls (14.0%). Similarly, [PERSON] et al. [7] reported that the prevalence of the CILCA type 2 variant was significantly higher (23.7%) in patients with thoracic aortic aneurysms or dissections compared to controls (15.9%). A recent systematic review and meta-analysis [8], including 8 studies for a total of 11,381 subjects, showed that the rate of thoracic aortic disease among patients with CILCA was higher than that seen in patients with standard aortic arch configuration (odds ratio 1.4, 95% confidence interval 1.068-1.839). [PERSON] et al. [9] reported a significant general association between aortic arch variants and type B aortic dissections, with patients with CILCA accounting for 33.5% of cases. This increase in the likelihood of thoracic aortic disease has been related to alterations in blood flow caused by the CILCA, generating areas of accelerated flow and heightened wall shear stress [9], which are linked to endothelial damage and arterial injury [10]. Furthermore, after dissection, patients with CILCA are more likely to undergo surgical aortic repair and present an increased risk of death [9; 11]. As a consequence, an early identification of patients with CILCA may be beneficial as it could allow the implementation of tailored surveillance protocols in order to avert unexpected disease diagnoses and potential adverse events. Computed tomography (CT) scans of the chest that include the supra-aortic vessels in the field of view may allow the detection of CILCA, in particular when contrast media is administered. However, notwithstanding CILCA is estimated with a prevalence varying from 8.0% to 35.2% [7; 11; 12; 13], this assessment is not part of routine clinical practice of CT, especially for CT scans not performed for cardiovascular indications [14]. As a consequence, CILCA is only incidentally found and rarely reported in CT diagnostics reports [9].