The Kommerell diverticulum revisited: embryogenesis, imaging findings of various types and clinical implications

This poster is published under an open license. Please read the disclaimer for further details.

Congress:

ECR 2016

Poster Number:

C-1401

Type:

Educational Exhibit

Keywords:

Arteries / Aorta, Cardiovascular system, Vascular, CT-Angiography, Computer Applications-Detection, diagnosis, Contrast agent-intravenous, Diverticula, Aneurysms, Congenital

Authors:

H. Sahin¹, F. C. Sarioglu¹, Y. Pekcevik¹, E. Akay², A. E. Çapar³, O. Oztekin¹, D. Oncel¹; ¹Izmir/TR, ²İzmir/TR, ³İZMİR/TR

DOI:

10.1594/ecr2016/C-1401

DOI-Link:

https://dx.doi.org/10.1594/ecr2016/C-1401

Fig. 1: Schematic drawing of the Kommerell Diverticulum (arrow) at the right aortic...

Fig. 2: An asymptomatic 23 year-old male. Anteroposterior (a) and left posterior...

Fig. 3: Axial plane computed tomography image of the same case in figure 1, shows...

Fig. 4: MIP images of two different cases with right aortic arch and the Kommerell...

Learning objectives

To review embryological development of the Kommerell diverticulum (KD) To discuss multidedector computed tomography (CT) angiography imaging findings of different types of the KD To discuss clinical evaluation of the KD with current treatment approach.

Background

Kommerell diverticulum (KD) is a congenital dilatation of the aortic arch which is seen as an outpouching in the distal part of the aortic arch. It was first reported by a German radiologist, Burckhard F. Kommerell, in a live patient during esophagography in 1936. He described an aortic diverticulum, which bears his name today, in a patient with a left aortic arch and aberrant right subclavian artery. This diverticulum is also known as “lusoria diverticulum”, “remnant diverticulum” or “lusoria root” [1]. Although most patients with...

Findings and procedure details

In the literature, different types of KD are reported [3, 4]. 1. Diverticulum at the right aortic arch (RAA) with aberrant left subclavian artery (ALSA) ( Fig. 1 ) Most common type reported ( Fig. 2 ) Embryological development: incomplete regression in the fourth left aortic arch between the left carotid and left subclavian arteries Represents a remnant of the primitive left aortic arch Aberrant subclavian artery usually courses posterior to the esophagus (80% of cases), but also may pass between esophagus and trachea (15%)...

Conclusion

Kommerell diverticulum is a rare vascular variation which usually accompanies an aberrant subclavian artery. Since it may be seen in various forms with accompanying different aortic arch anomalies, radiologists, vascular and thoracic surgeons should be aware of CT angiography features of the KD and related pathologies such as vascular ring or organ compression for appropriate treatment approach.

Personal information

References

Baranhas AD, Indiani JMC, Marchiori E et al. Atypical presentation of Kommerell's diverticulum. Arq Bras Cardiol 2009;93(6):e88-e90 Vucemilo I, Harlock JA, Qadura M, Guirgis M, Gowinga RN, Tittley JG. Hybrid repair of symptomatic aberrant right subclavian artery and Kommerell's diverticulum. Ann Vasc Surg 2014;28:411-420 Lv P, Lin J, Zhang W, Hu J. Computed tomography findings of Kommerell Diverticulum. Can Assoc Radiol J 2014;65(4):321-326 Balani A, Marda SS, Kumar AD, Alwala S. Kommerell's diverticulum: unusual case expanding the horizon. Can Assoc Radiol J 2015;66(3):298-299 Chung JH,...