Crossed pulmonary arteries as additional cause of dysphagia in association with right aortic arch and Kommerell diverticulum (original) (raw)
Related papers
Journal of Institute of Medicine Nepal
Congenital variations and anomalies of the aortic arch are important entity in vascular imaging. Most of them are asymptomatic. About 30-40% presents with tracheo-oesophageal symptoms like dyspnea and dysphagia. A 27 year-old female presented with persistent dysphagia for 6 months duration and cause of persistent dysphagia was the right sided aortic arch with aberrant left subcalvian artery from Kommerell’s diverticulum. The diagnosis was made through combination of chest X-Ray, echocardiography, non-ionic contrast swallow and Computed Tomography angiography. Non-invasive modalities (CT and MR Angiography) play an important role in diagnosis and pre-operative surgical planning providing relationship with the surrounding structures especially trachea and esophagus.
Right Aortic Arch With Kommerell Diverticulum: A Rare Cause of Dysphagia
JAMA otolaryngology-- head & neck surgery, 2014
IMPORTANCE Dysphagia is a common condition with multiple causes. Fortunately, a thorough evaluation will often lead to a correct diagnosis, even when the cause is a rare entity. A right aortic arch with associated aberrant left subclavian artery is an uncommon anatomical variant. Physicians involved in the management of dysphagia should be aware of vascular anomalies that can cause dysphagia. OBSERVATIONS We report a case of a young patient who presented with dysphagia caused by a right aortic arch, aberrant left subclavian artery, and associated Kommerell diverticulum, a remnant of the left dorsal arch. CONCLUSIONS AND RELEVANCE Kommerell diverticulum, a remnant of the left dorsal arch, is a rare cause of dysphagia. However, vascular causes should be considered in the algorithm when evaluating patients who present with dysphagia, especially when there is compression of the esophagus noted on imaging or examination.
Right Subclavian Artery With Kommerell's Diverticulum: A Rare Cause of Dysphagia
Cureus Journal of Medical Sciences, 2023
Kommerell's diverticulum is an embryologic developmental anomaly of the aortic arch wherein a diverticulum arises from either the left or the right aortic arch. It results due to the persistence of the remnant of the fourth dorsal aortic arch. We present a case of a 66-year-old female presenting with complaints of throat pain and difficulty swallowing. A computed tomography (CT) scan of the neck with contrast revealed an incidental finding of an aberrant right subclavian artery with associated diverticula of Kommerell, measuring up to 1 cm, causing a mass effect on the esophagus and posterior trachea. A diagnosis of dysphagia lusoria was established, and an upper gastrointestinal (GI) series revealed narrowing of the esophagus from posterior extrinsic compression. The patient was discharged home for nutrition optimization with a percutaneous endoscopic gastrostomy (PEG) tube due to significant weight loss from the inability to swallow before proceeding with surgery to repair the aberrant right subclavian artery.
Kommerell's diverticulum and right-sided aortic arch: a cohort study and review of the literature
Journal of Vascular Surgery, 2004
We report four consecutive cases of Kommerell's aneurysm of an aberrant left subclavian artery in patients with a right-sided aortic arch and the results of a systematic review of the literature. In our cohort of patients, three had an aneurysm limited to the origin of the aberrant subclavian artery, causing dysphagia and cough, and one had an aneurysm involving also the distal arch and the entire descending thoracic aorta, causing compression of the right main-stem bronchus. A left subclavian-to-carotid transposition was performed in association with the intrathoracic procedure, and a right thoracotomy was used in all patients. One of the patients underwent surgery with deep hypothermia and circulatory arrest, and the others with the adjunct of a left-heart bypass. The repair was accomplished with an interposition graft in two patients and with endoaneurysmorrhaphy in the others. The postoperative course was complicated by respiratory failure and prolonged ventilation in one patient, and one patient died because of severe pulmonary emboli. The survivors are alive and well at a follow-up of 1 to 3 years. Only 32 cases of right-sided aortic arch with an aneurysm of the aberrant subclavian artery have been reported: 12 were associated with aortic dissection, and 2 presented with rupture. Surgical repair was accomplished in 29 patients. A number of operative strategies were described: right thoracotomy, bilateral thoracotomy, left thoracotomy with sternotomy, sternotomy with right thoracotomy, and left thoracotomy. In only 12 cases was the subclavian artery reconstructed. We believe that a right thoracotomy provides good exposure and avoids the morbidity associated with bilateral thoracotomy or sternotomy and thoracotomy. We feel that a left subclavian-to-carotid transposition completed before the thoracic approach revascularizes the subclavian distribution without increasing the complexity of the intrathoracic procedure. (
Case reports in cardiology, 2017
A 49-year-old African American male patient with no past medical history was admitted because of 3 months of difficulty swallowing solid and liquid foods. He had constant retrosternal discomfort and appeared malnourished. The chest radiograph revealed a right sided aortic arch with tracheal deviation to the left. A swallow study confirmed a fixed esophageal narrowing at the level of T6. Contrast enhanced Computed Tomography (CT) angiogram of the chest and neck revealed a mirror image right aortic arch with a left sided cardiac apex and a prominent ductus diverticulum (measuring 1.7 × 1.8 cm). This structure extended posterior to and indented the mid esophagus. A left posterolateral thoracotomy was performed and the ductus diverticulum was resected. A retroesophageal ligamentum arteriosum was found during surgery and divided. This rare combination of congenital anatomical aberrations led to severe dysphagia in our patient. Successful surgical correction in the form of resection of th...
2021
Aberrant Subclavian Artery (ASA) is a rare anomaly within the aortic arch. In some cases, an aneurysm can also develop in the proximal ostium of the ASA which is called Kommerell diverticulum. In this article we report two symptomatic patients with a rare anatomical anomaly caused by a right sided aortic arch and left aberrant subclavian artery with Kommerell diverticulum causing dysphagia lusoria. In the first patient with hemoptysis we conducted surgical excision of the left subclavian artery origin along with bypass end-to-side bypass grafting. In the second patient we transected and ligated the left subclavian artery and with an end-to-side bypass transposition graft, followed by thoracic endovascular repair with simultaneous coil embolization of the Kommerell diverticulum.
Journal of Vascular Surgery, 2000
A right-sided aortic arch is an anatomic variant occurring in approximately 0.1% of the population, 1 and in half of these cases the left subclavian artery is also aberrant. 2,3 These anomalies may be isolated or occur in combination with congenital heart defects. We conducted a review of the literature and report one case of a Kommerell's diverticulum of an aberrant left subclavian artery in a patient with a right-sided aortic arch and a descending thoracic aortic aneurysm.
Journal of Cardiovascular Development and Disease
Background: Kommerell’s diverticulum is a rare vascular anomaly characterized as an outpouch at the onset of an aberrant subclavian artery. In the variant of a right-sided aortic arch, the trachea and esophagus are enclosed dorsally by the arch. In the configuration of an aberrant left subclavian artery, a Kommerell’s diverticulum and persisting ductus arteriosus or ductal ligament enclose the lateral side, forming a vascular ring which may result in (symptomatic) esophageal or tracheal compression. Spontaneous rupture of an aneurysmatic Kommerell’s diverticulum has also been reported. Due to the rarity of this condition and underreporting in the literature, the clinical implications of a Kommerell’s diverticulum are not well defined. Case summary: We describe seven consecutive adult patients with a right-sided aortic arch and an aberrant course of the left subclavian artery (arteria lusoria), and a Kommerell’s diverticulum, diagnosed in our tertiary hospital. One patient had severe...
Considering an aortic arch anomaly in patients with dysphagia
Journal of the American Academy of Physician Assistants, 2013
SPECIAL TOPICS IN CARDIOLOGY P atients who present with dysphagia or dyspnea may have a congenital anomaly known as retroesophageal right subclavian artery. People with this anomaly typically are asymptomatic. Atherosclerosis can produce symptoms in older adults. In children, retroesophageal right subclavian artery also can cause dyspnea and recurrent respiratory infections without other identifi able causes. Normally, the aortic arch gives rise to the right brachiocephalic trunk, left common carotid, and left subclavian artery. The brachiocephalic trunk superiorly bifurcates into the right subclavian artery and right common carotid artery (Figures 1 and 2). 1 However, vascular dissimilarities in patients are common because the circulatory system will anatomically adapt as needed based on demand. Vascular anatomical anomalies such as retroesophageal right subclavian artery are an exceptionally rare occurrence in the cadaver laboratory. Dissection discoveries of this nature provide students and faculty with an enhanced appreciation of human anatomical disparities. CASE A right subclavian artery variant was revealed during a routine arterial dissection of a 64-year-old male cadaver. A complete anterolateral thoracotomy, sternotomy, and anterolateral abdominal wall excision was performed. The pericardial sac was divided and resection was performed on all organs with associated branches from the aorta. The arterial dissection was started at the level of the ventriculoaortic junction continuing distally to include excision of the bilateral external and internal iliac arteries. On examination of the aortic arch, the classic branches one would expect to see were not evident. From right to left, the fi rst branch visualized was the right common carotid, followed