Aortography and computed tomographic scans revealed the aberrant right subclavian artery arising from a calcified aneurysm of the kommerell s diverticulum and bilateral carotid artery disease with atherosclerotic narrowing. Burckhard friedrich kommerells scholarly description of the aortic diverticulum that bears his name was published in 1936. A possible etiology of the subclavian arterys anomalous origin would be an abnormality in regression of the fourth primitive aortic arch during embryonic development. Any information contained in this pdf file is automatically generated from digital material. Dissected aberrant right subclavian artery with kommerell diverticulum.
Right descending aorta with leftsided kommerell diverticulum, typically giving rise to the left sca, which originates in a kink. We report a case of a 57yearold man with right aortic arch, kommerells diverticulum, and aberrant left subclavian artery. The right ventral aorta give origin to the brachycephalic arterial trunk, from which the right common carotid artery and the right subclavian artery emerge, this last one has a tripartite origin, the proximal part derives from the right fourth aortic rstridor, the intermediate segment from the right dorsal aorta between this arch etridor the origin of the seventh segmentary artery, this last. Vascular anomalies such as kommerells diverticulum, though uncommon, should be considered in the differential diagnosis of chronic cough particularly when other common causes have been ruled out. The enlargement of the kommerell s diverticulum by itself and the slinglike effect of the left subclavian artery, which pulls the right aortic arch towards left side, are responsible for compression of the trachea. Surgical treatment for kommerells diverticulum sciencedirect. Kommerell diverticula occur in some anomalies of the aortic arch system. A 62yearold male presented to the outpatient department of chest with history of dry cough since two months and swelling on the anterior aspect of neck of 30year duration. It is an uncommon condition that occurs in association with a left aortic arch. A rightsided aortic arch with kommerells diverticulum of.
Kommerell s diverticulum is a rare, congenital aortic arch anomaly, usually associated with other vascular abnormalities. It usually refers to the bulbous configuration of the origin of an aberrant left subclavian artery in the setting of a rightsided aortic arch. Aberrant right subclavian artery and kommerells diverticulum. A case of an 11monthsold girl with vomiting and laryngeal stridor is presented, and in whom a kommerell diverticulum was demonstrated, which is a rare variant of the incomplete vascular ring. 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. Introduction the aim of the study is to report our initial experience with combined open surgical treatment and endovascular therapy in the treatment of complex. The enlargement of the kommerells diverticulum by itself and the slinglike effect of the left subclavian artery, which pulls the right aortic arch towards left. Kommerell diverticulum and aberrant right subclavian artery. However planning the strategy of operation is difficult without a 3d imaging.
Conclusions and relevance kommerell diverticulum, a remnant of the left dorsal arch, is a rare cause of dysphagia. Kommerell diverticulum radiology reference article. Hybrid repair of penetrating aortic ulcer associated with right aortic arch and aberrant left innominate artery arising from aneurysmal kommerells diverticulum with simultaneous repair of bilateral common iliac artery aneurysms. Surgical relief was accomplished by excluding the aneurysm from circulation through the aortic arch and a 10 mm. However, further imaging studies revealed presence of another associated pathology, a kommerells diverticulum in association with a right aortic arch with aberrant left. We present biographical information about kommerell, as supplied by family members, and comment on the surgical relevance of. A rightsided aortic arch is an anatomic variant occurring in approximately 0. A case of an 11monthsold girl with vomiting and laryngeal stridor is presented, and in whom a kommerell diverticulum was demonstrated, which is a rare variant. Kommerells diverticulum and aneurysmal rightsided aortic.
Arteria subclavia derecha aberrante y disfagia lusoria. Any information contained in this pdf file is automatically generated from digital material submitted to epos by third parties in the form of scientific presentations. The strategy of surgical treatment for kommerells diverticulum has not been established. It is a pouch that forms in your pharynx, an area just above your esophagus or swallowing tube. In the international literature, however, the name of kommerell survives only as an eponym.
This happens when there is pressure on your pharynx and it balloons out. Aberrant right subclavian artery arsa with kommerells diverticulum, is a rare congenital anomaly of the aortic arch found at postmorten examination with a frequency of 0,5%. Though the diverticulum can present with chest symptoms or dysphagia, it may not always cause symptoms 1, 3. Kommerell diverticulum definition of kommerell diverticulum. The presence of an aberrant right subclavian artery is an infrequent finding 0. Atypical presentation of kommerells diverticulum scielo. Between 1994 and 2004, 6 patients underwent surgery for kommerells diverticulum at our. Because there is a tendency not to report mortalities of these rare. Aberrant right subclavian artery is the most frequent anomaly of the aortic arch. When present with a concurrent rightsided aortic arch and an aberrant. Diverticulitis trastornos gastrointestinales manual msd. Kommerells diverticulum, which is a rare condition, is a congenital abnormality of the aortic arch. There is a common wall that separates the esophagus from the diverticulum pouch.
Zenkers diverticulum repair what is zenkers diverticulum. Page 3 of 15 learning objectives the aberrant right subclavian artery is the most common embryological anomaly of the aortic arch and more than half of cases are associated with a kommerell s diveticulum. Right aortic arch with aberrant left subclavian artery from a kommerells diverticulum is a very rare variant of the. The right aberrant subclavian artery or arteria lusoria is the most common anatomical variant of the. In this lesion the right subclavian artery arises as the fourth branch of the aorta distal to the origin of the left subclavian artery, then comes to the right arm posterior to the esophagous. The symptoms can be more frequent because of right sided aortic arch with aberrant left subclavian artery alsa. The diagnosis of the several types of aortic arch diverticulum is important due to. Stenotic origin of an aberrant left subclavian artery from a rightsided aortic arch.
Right aortic arch and kommerells diverticulum repaired. It is unusual nomenclature, in that focal dilatations of a. Before and during world war i, he studied at the schiller gymnasium in berlin 19101920, where he. This saccular aneurysmal dilation at the origin of aberrant subclavian artery consists of an aneurysm of the thoracic aorta as well as an aneurysmal opening of an aberrant subclavian artery 2, 3. References to any names, marks, products, or services of third parties or hypertext links to third.
Surgical treatment is recommended for symptomatic patients or asymptomatic patients with a large diverticulum. Tracheacompressie door divertikel van kommerell bij een. Right aortic arch with kommerells diverticulum is a very rare situation. Burckhard kommerell described an aortic diverticulum for the first time in 1936 in a living patient. We present the case of a 54yearold man with thoracic pain due to dissection of an. The left cca is the first branch given off by the ascending aorta. Aberrant right subclavian artery and kommerells diverticulum associated with aortic dissection and vascular rupture. A case report viviane tiemi hotta1,2, andrei skromov albuquerque1,3, valdir ambrosio moises1,4. We report a 72 yearold man with dysphagia and dizziness. A very rare congenital malformation of the heart that is usually benign.
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