Kommerell diverticula occur in some anomalies of the aortic arch system. It usually refers to the bulbous configuration of the origin of an aberrant left subclavian artery in the setting of a right-sided aortic arch. However, it was originally described as a diverticular outpouching at the origin of an aberrant right subclavian artery with a left-sided aortic arch.
Kommerell diverticulum may be asymptomatic, or cause symptoms of oesophageal or tracheal obstruction.
On chest radiographs, a small rounded density may be seen laterally towards the left of the trachea.
On barium swallow, an impression can be seen from the left side of the oesophagus simulating a double aortic arch.
Typically shows bulbous enlargement of the proximal subclavian artery at its origin from the aortic arch, posterior to the oesophagus.
Treatment and prognosis
Given the rarity of this condition, there is no established management guideline. Options include aortic replacement or thoracic endovascular stent-graft replacement (TEVAR), and extra-anatomic bypass of the aberrant subclavian artery 6,7.
The major complications of Kommerell diverticulum are rupture or dissection 7.
History and etymology
It is named after Burckhard F Kommerell, a German radiologist (1901-1990).
- 1. Dähnert W. Radiology Review Manual. Lippincott Williams & Wilkins. (2007) ISBN:0781766206. Read it at Google Books
- 2. Van son JA, Konstantinov IE. Burckhard F. Kommerell and Kommerell's diverticulum. Tex Heart Inst J. 2002;29 (2): 109-12. - Free text at pubmed - Pubmed citation
- 3. Welch TJ, Mckusick MA. Cardiovascular case of the day. Case 2: Aneurysm of aberrant right subclavian arising from diverticulum of Kommerell. AJR Am J Roentgenol. 1993;160 (6): 1313-4. AJR Am J Roentgenol (citation) - Pubmed citation
- 4. Carbone I, Sedati P, Galea N et-al. Right-sided aortic arch with Kommerell's diverticulum: 64-DCTA with 3D reconstructions. Thorax. 2008;63 (7): 662. Thorax (full text) - doi:10.1136/thx.2007.087072 - Pubmed citation
- 5. Berdon WE. Rings, slings, and other things: vascular compression of the infant trachea updated from the midcentury to the millennium-the legacy of Robert E. Gross, MD, and Edward B. D. Neuhauser, MD. Radiology. 2000;216 (3): 624-32. Radiology (full text) - Pubmed citation
- 6. Ota T, Okada K, Takanashi S et-al. Surgical treatment for Kommerell's diverticulum. J. Thorac. Cardiovasc. Surg. 2006;131 (3): 574-8. doi:10.1016/j.jtcvs.2005.10.012 - Pubmed citation
- 7. Knepper J, Criado E. Surgical treatment of Kommerell's diverticulum and other saccular arch aneurysms. J. Vasc. Surg. 2013;57 (4): 951-4. doi:10.1016/j.jvs.2012.10.094 - Pubmed citation
- acute aortic syndrome
- thoracic aortic aneurysm
- abdominal aortic aneurysm
- endovascular aneurysm repair (EVAR)
- reporting tips for aortic aneurysms
- aortic coarctation
- aortic pseudocoarctation
- cervical aortic arch
- interrupted aortic arch
- transposition of the great arteries
- variant anatomy of the aortic arch
- traumatic aortic injury