Right Sided Aortic Arch with Aberrant Left Subclavian Artery from Kommerell’s Diverticulum, a Cause of Persistent Dysphagia in an Adult: A Case Report (original) (raw)
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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.
Surgical and radiologic anatomy : SRA, 2018
We describe an uncommon association of crossed pulmonary arteries and a right aortic arch with a Kommerell diverticulum and a left ligamentum arteriosum, resulting in disabling dysphagia in a 33-year-old woman. First, endovascular exclusion of the Kommerell diverticulum was performed using a thoracic stent graft, associated with left subclavian-carotid transposition. Second, open aneurysmorrhaphy and division of the left ligamentum arteriosum allowed a proper release of the oesophageal compression. Dysphagia completely disappeared in the postoperative course. Control computed tomography angiography at 6-month follow-up showed a satisfactory hybrid repair. A complete understanding of the combined effects of these two anatomical variations on oesophageal compression led to a suitable surgical management.
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 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...
American Journal of Case Reports, 2019
Objective: Rare disease Background: Kommerell diverticulum with a right-sided aortic arch is a rare congenital anatomical condition most often observed in adults. A possible etiology of the subclavian artery's anomalous origin would be an abnormality in regression of the fourth primitive aortic arch during embryonic development. Case Report: We report on the case of a 16-year-old female patient presenting with complaints of occasional tachycardia and mild non-specific dyspnea after anxiety crises. Physical examination revealed lower amplitude of the pulses in the left upper limb compared to the right upper limb, and difference in blood pressure (BP) values of 80×60 mmHg, and 100×60 mmHg, respectively. Different radiological imaging modalities were performed to elucidate a possible vascular abnormality. Multislice detector computed tomography angiography of the thoracic aorta and supra-aortic trunks showed a right-sided aortic arch and an aberrant origin of the left subclavian artery with a retroesophageal course and dilation of its emergence (Kommerell diverticulum), as well as duplicity of the right vertebral artery (RVA). Considering the actual small diameter of the diverticulum and the absence of dysphagia or severe external esophageal compression analyzed by the esophagogram, vascular surgery was not indicated. Since complications have been described in the literature, the patient must be kept under observation in the future. Conclusions: Congenital vascular alterations, including Kommerell diverticulum with right-sided aortic arch and the aberrant origin of the left subclavian artery, should be suspected in otherwise asymptomatic young patients with few clinical manifestations. Investigation with different imaging methods helps to clarify the vascular abnormalities, to support a possible surgical procedure indication, and to monitor the patients in follow-up.
Saudi journal of gastroenterology : official journal of the Saudi Gastroenterology Association
A 45-year-old woman presented to the surgery outpatient department with complaints of difficulty in swallowing, predominantly solid food, for the past 6 months. She had lost about 7 kg weight in the last 3 months due to difficulty in food intake since the patient was mostly on liquid diet. She had no history of chronic heartburn, smoking, fever, or altered bowel habits. Routine blood investigations were within normal limits. She was advised barium swallow and subsequently was advised contrast-enhanced computed tomography (CECT) thorax. Barium swallow showed smooth external indentation on the esophagus, predominantly from right side and from posterior aspect with slight hold up of contrast [ ]. There was no evidence of stricture or mucosal irregularity. CECT thorax confirmed the barium findings and the diagnosis [ ].
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 Cardiac Surgery, 2012
Kommerell diverticulum (KD) with left aberrant subclavian artery is a rare congenital variation of vascular structure, and it can be asymptomatic or symptomatic owing to mass effect. Surgical intervention is recommended in symptomatic patients or asymptomatic patients with a large diverticulum because of possible dissection and rupture of Kommerell diverticulum. We report a case of right-sided aorta, KD, and left aberrant subclavian artery in a 74year-old man. He had no symptoms with KD.
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...