Kommerell diverticulum (KD) is a rare vascular anomaly typically involving a right-sided aortic arch with an aberrant left subclavian artery. However, variations like a left-sided arch with an aberrant right subclavian artery exist. This condition results from the persistence of an embryonic vascular remnant – the dorsal segment of an involuted fourth aortic arch.
The clinical manifestations of KD can range from mechanical compression of adjacent mediastinal structures (esophageal compression, dysphagia, tracheal narrowing, hoarseness) to life-threatening cardiovascular conditions (e.g., aortic dissection) due to an inherent structural weakness of the arterial wall at the diverticulum.
CT angiography is often the first imaging modality to catch KD. This video shows a coronal CT with a right carotid, left carotid, and left subclavian followed by an aberrant right subclavian with aneurysmal dilation of the KD and associated left hemothorax. Surgery, in this case, can involve an open resection with vascular reconstruction or an endovascular stent graft to exclude the KD from circulation with bypasses of the arch vessels. More conservative management can include routine surveillance imaging with good impulse control measures.
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