Presentation
Admitted with deep vein thrombosis. Investigated for chronic dysphagia.
Patient Data
Right-sided aortic arch, with tracheal deviation to the left. Also a certain degree of prominence of the right pulmonary arterial branches can be appreciated.
On barium swallow, there is smooth esophageal indentation, suggesting extrinsic compression.
Chest CTA demonstrates pulmonary emboli in the right and posterobasal pulmonary arteries (eccentrically positioned partial filling defect, surrounded by contrast material, forming acute angles with the arterial wall). No pulmonary infarction, pleural effusion nor pulmonary hypertension.
Right aortic arch with aberrant left subclavian artery demonstrated. This artery originates from a Kommerell diverticulum (dilation of its origin), has a retro-esophageal trajectory resulting in 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 CTPA 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's chronic dysphagia history.
Kommerell diverticula are 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 neoplasia.
Patient was treated with anticoagulants for DVT and PE.
Surgical treatment for the Kommerell diverticulum itself was contraindicated due to the high risk of adverse outcomes.