Kommerell’s diverticulum: a journey from diagnosis to management through five different cases.

Congress:

ECR 2020

Poster Number:

C-09792

Type:

Educational Exhibit

Keywords:

Not applicable, Dilatation, Stents, Diagnostic procedure, CT-Angiography, CT, Interventional vascular, Arteries / Aorta, Anatomy, Vascular

Authors:

S. Schiro', I. Paladini, A. Andreone, E. Epifani, C. Marcato, N. Sverzellati; Parma/IT

DOI:

10.26044/ecr2020/C-09792

DOI-Link:

https://dx.doi.org/10.26044/ecr2020/C-09792

Fig. 1

Fig. 2: Graphic representation of Kommerell's Diverticulum (KD) in a left (A) and right...

Fig. 4: Graphic representation of Idrees method for KD measurement in both left (A) and...

Fig. 5: 47-year-old, male, symptomatic. Angio-CT images (A-C) showing the KD in a right...

Learning objectives

Todescribe imaging findingsof Kommerell's Diverticulum (KD) Todiscusswhich are theoptimal therapeutic approachthrough five different cases.

Background

Kommerell’s Diverticulum (KD) is a congenital aortic variant. It’s a persistent remnant of the fourth primitive dorsal aortic arch, from which an aberrant subclavian artery arises either in a left or right aortic arch[1, 2]. Aberrant subclavian artery is found in the 1% of population and KD is present in about 60% of cases[3]. There are two different types of KD: type I in a left sided aortic arch with a right aberrant subclavian artery(Fig.2A) type II in a right sided aortic arch with a...

Findings and procedure details

Case 1«symptomatic subclavian steal syndrome» 47-year-old, male,Asian Clinical history For 2 years, dizziness at postural movements and by using left upper limb. Different upper limbs arterial pressure:R=130/90mmHg; L=100/90mmHg(differential systolic: 30mmHg) Imaging: DUS:reverse flow in left vertebral artery -> LSA: PSV 80cm/sec; RSA: PSV 180 cm/sec Transcranic Doppler: vertebro-basilar flow is sustained by right vertebral artery CT imaging findings:Kommerell’s diverticulum(Type II)with punctuate opening of aberrantleftsubclavian artery(Fig.5). KD size= 45x28 mm Angiography findings:Left subclavian artery stenosis sustained reverse left vertebral artery flux confirming a subclavian steal syndrome(Fig.6)....

Conclusion

KD is a rare condition yet potentially fatal. Be aware of its presence is fundamental for the appropriate characterization and proper management.

Personal information and conflict of interest

S. Schiro'; Parma/IT - nothing to disclose I. Paladini; Parma/IT - nothing to disclose A. Andreone; Parma/IT - nothing to disclose E. Epifani; Parma/IT - nothing to disclose C. Marcato; Parma, ITALY/IT - nothing to disclose N. Sverzellati; Parma/IT - nothing to disclose

References

1.Tanaka A, Milner R, Ota T. Kommerell's diverticulum in the current era: a comprehensive review. Gen Thorac Cardiovasc Surg. 2015;63(5):245-59. 2.Hanneman K, Newman B, Chan F. Congenital Variants and Anomalies of the Aortic Arch. Radiographics. 2017;37(1):32-51. 3.Wong HL, Liew CJY, Poh ACC. Saccular Kommerell aneurysm, a potential pitfall on MDCT imaging - A review of imaging features and potential mimics. Eur J Radiol Open. 2017;4:89-94. 4.Felson B. Ruptured anomalous right subclavian artery: aneurysm or diverticulum? Semin Roentgenol. 1989;24(2):121-6. 5.Idrees J, Keshavamurthy S, Subramanian S, Clair...