Kommerell diverticulum

Case contributed by Dr Elias Bajotto Adaime

Presentation

Patient hospitalized with deep vein thrombosis. History of cronic dysphagia.

Patient Data

Age: 80
Gender: Male
Modality: X-ray

Chest x-ray shows right sided aortic arch, with tracheal deviation to the left. Also, a certain degree of right pulmonary arterial branches proeminence can be noticed.

Modality: Barium

On barium swallow, we identify smooth esophageal indentation, suggesting extrinsic compression.

Modality: CT

Chest CTA demonstrates a pulmonary embolus in the right and posterobasal pulmonary arteries, that results in an eccentrically positioned partial filling defect, which is surrounded by contrast material and forms acute angles with the arterial wall. Pulmonary infarction was absent. No signs of pleural effusion nor pulmonary hypertension.

Right aortic arch with aberrant left subclavian artery was observed. This artery originates from a Kommerell diverticulum (dilation of its origin), has a retro-esophageal traject and produces tracheo-esophageal compression with left deviation.

Case Discussion

Patient was hospitalized due to acute lower limb deep vein thrombosis (DVT) and dyspnea, thus being referred to chest CTA and diagnosed with pulmonary embolism (PE).

As an incidental finding, a right sided aortic arch with an aberrant left subclavian artery, originating itself within a Kommerell diverticulum was identified, causing deviation and bulging over proximal trachea and esophagus. These findings were consistent with the patient chronic dysphagia history.

Kommerell's diverticulum can occur in a number of anomalies of the aortic arch system that can, but do not always, cause symptoms of tracheal or esophageal compression. The diverticulum is most frequently present in cases of right aortic arch with an aberrant left subclavian artery. In this anomaly, the left subclavian artery arises from the right-sided aortic arch as the 4th branch and passes behind the esophagus to the left arm.

Upper endoscopic study did not show evidence of neoplasy.

Patient was treated with anticoagulants for DVT and PE.

Surgical treatment for the Kommerell diverticulum was contraindicated due to high risk of adverse outcomes.

 

 

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Case Information

rID: 52034
Case created: 18th Mar 2017
Last edited: 4th Apr 2017
System: Vascular
Inclusion in quiz mode: Included

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