Left isomerism with Kommerell diverticulum and interventricular membranous septal diverticulum
Presentation
CT scan requested from cardiologist for aortic aneurysm
Patient Data
The distal aortic arch is dilated with an aneurysmal origin of the retro-esophageal aberrant right subclavian artery (Kommerell diverticulum).
There are thoracic and abdominal anatomic variants and anomalies:
- atrial situs, atrioventricular and ventriculoarterial connections are normal; one may discuss two atria with left morphology. No abnormal pulmonary venous return. There is absence of the hepatic segment of the IVC with azygos continuation. No persistent left SVC.
- the bilateral mainstem bronchi show left morphology and each lungs have two lobes and one fissure (bilateral bilobed lungs)
- liver and gallbladder are essentially median in position
- polysplenia
- the stomach is on the right, small bowel loops all located on the left, large bowel is located on the right: findings suggestive of a mirrored intestinal nonrotation
- mesenteric vessels are reversed
There is a pouch-like structure located below the level of the aortic valve annulus, consistent with a membranous diverticulum of the interventricular septum, while the sinus of Valsalva and aortic valve cusps are grossly normal.
This case is a joint interpretation of imaging with Dr P. Mascarel, who is the prime reporter.
Case Discussion
This case is exceptional through association of three findings:
- an aberrant right subclavian artery with aneurysmal Kommerell diverticulum
- complete, typical left isomerism (polysplenia syndrome)
- diverticulum of the interventricular membranous septum
Case uploaded with the permission of referring radiologist Dr. Patrick Mascarel.
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