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 .
These associated malformations can cause distal embolization,
compression of adjacent structures,
vascular rupture and dissection.
New imaging modalities,
such is the case of cardiovascular multisliced computed tomography allow us to better assess the complex and unusual vascular diseases.
Our aim is to review the embriology,
anatomy,
and imaging diagnostic of this disease,
focusing on what the radiologist...
Background
A right-sided aortic arch is the result of an abnormal organogenesis of primitive aortic arches.
Between the fourth and fifth weeks of embryonic life,
blood leaves the heart by a single vessel,
the truncus arteriosus,
which divides into two branches,
the ventral aortae.
These are connected with the paired dorsal aortae by six branchial vessels,
called aortic arches.
Segments of the first three arches,
together with their dorsal and ventral aortic connections,
form the carotid system.
A segment of the right ventral aorta,
the right...
Imaging findings OR Procedure details
We report a dissectionof the distal arch and descending thoracic aorta in a patient with right-sided arch Fig. 1 Fig. 2 Fig. 3 .In our patient,the left subclavian artery originated at the junction between the distal arch and thedescending thoracic aorta located in the right chest and was aneurysmal (Kommerell’sdiverticulum) Fig. 4 Fig. 5 Fig. 6 .
The patient was a50-year-old obesemale withhypertensionand obesity,
no malformation was known previously and took no medication.
The dissecion involved too the abdominal aorta,
left iliac artery,
celiac artery,...
Conclusion
Acquired cardiovascular diseases can modify the clinic manifestations of a vascular congenital anomaly.
Our case in an example of how,
with the use of advanced medical technology,
we can study with detail those complex pathologies.
As times goes by,
frecuency of interations between congenit and acquired conditions may increase because of the growing of the prevalence of vascular diseases in the population.
The radiologist must know this and include this possible association in the diagnostic evaluation of the patients.
References
1.Kommerell’s diverticulum and aneurysmalright-sided aortic arch: A case report andreview of the literatureClaudio S.
Cinà,
MD,
FRCSC,
Goffredo O.
Arena,
MD,
Gerard Bruin,MD,
FRCPC,
and Catherine M.
Clase,
MSc,
FRCP.Journal of Vascular SurgeryVolume 32,
Number 6
2.Burckhard F.
Kommerelland Kommerell´sDiverticulum.
Jacques A.M.
van Son,MD,
PhDIgor E.
Konstantinov,
MD.
Texas Heart Institute JournalVolume 9,
Number 2,
2002.
3.
Arteria subclavia derecha aberrante y divertículo deKommerell asociados a disección de aorta tipo B yruptura vascular.Javier Courtis.Rev Fed Arg Cardiol 2010; 39 (4): 314-318.
4.Kommerell’s Diverticulum,
Risk Factorfor...