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Kommerell Diverticulum


Presentation

  • We present a hybrid endovascular approach to a 6.5-cm aneurysm of the right-sided aortic arch with an aberrant left subclavian artery arising from a Kommerell diverticulum, connected to the left pulmonary artery through the ligamentum arteriosum.[ncbi.nlm.nih.gov]
  • Frequently, an aortic out pouching, or Kommerell diverticulum (KD) is present at the ARSA aortic origin. Patients may present with “dysphagia lusoria” if the ARSA and KD compresses the esophagus posteriorly.[symposium.scvs.org]
  • In this article, we report the case of a 68-year-old woman who presented with shortness of breath. Respiratory function tests showed a slightly obstructive physiology.[ncbi.nlm.nih.gov]
  • The present article describes a surgical method of complete repair with division of the rudimentary left arch, resection of the diverticulum, and transposition of the left subclavian artery.[ncbi.nlm.nih.gov]
  • We present a patient with dyspnea on exertion and pseudo asthma. This 11-year-old male presents with progressive dyspnea on exertion, “sounds wheezy”. He has no syncope.[scholarworks.wmich.edu]
Mediastinal Lymphadenopathy
  • Lung cancer is seen involving the left inferior lobe (lung window not shown), with associated mediastinal lymphadenopathy. Accessorily, a small hiatal herniation is seen.[radiopaedia.org]
Falling
  • The sling-like effect of the left subclavian artery is not as intuitively obvious, but the release of the right aortic arch, allowing it to fall into the right chest and away from the trachea, is fairly dramatic when pre- and postoperative bronchoscopy[academic.oup.com]
Lymphadenopathy
  • Lung cancer is seen involving the left inferior lobe (lung window not shown), with associated mediastinal lymphadenopathy. Accessorily, a small hiatal herniation is seen.[radiopaedia.org]
Weight Gain
  • Follow-up at one month revealed resolution of dysphagia, weight gain and symmetric radial pulses. A PUBMED literature review of 33 cases performed from 1998-2012 reveals good early and mid-term results using endovascular and hybrid procedures.[symposium.scvs.org]
Burning Pain
  • Case report Male, 65-year-old patient who referred having regurgitation (reflux) and retrosternal burning pain in the middle of the night.[scielo.br]
Weakness
  • The first documented surgical repair of subclavian artery aberrancy was performed by Robert Gross in 1946 and consisted of simple ligation of the aberrant vessel at its origin. 6 A drawback of this surgery was left or right arm weakness dependent on the[jamanetwork.com]
Hoarseness
  • Hoarseness and left ptosis recovered spontaneously 3 months after surgery, and the patient remained symptom-free at the 1-year follow-up.[ncbi.nlm.nih.gov]
Ptosis
  • Complications after aberrant subclavian artery revascularization were transient ptosis (n 3), graft occlusion (n 1), recurrent laryngeal nerve injury (n 1),phrenic nerve injury (n 1), and reintubation (n 1).[ncbi.nlm.nih.gov]
  • Hoarseness and left ptosis recovered spontaneously 3 months after surgery, and the patient remained symptom-free at the 1-year follow-up.[ncbi.nlm.nih.gov]

Workup

  • Subsequent workup consisted of chest X ray, barium esophagram and a computed tomography (CT) scan of the neck. Chest X-ray showed prominent right aortic arch and slight deviation of trachea to left side (Figure 1) (Figure 2) .[ijcasereportsandimages.com]

Treatment

  • […] and harvest of the femoropopliteal vein; and endovascular treatment of aortic arch vessels, subclavian and axillary artery.[books.google.com]
  • Surgical treatment for Kommerell’s diverticulum. J Thorac Cardiovasc Surg. 2006 ; 131 : 574–578. Crossref Medline Google Scholar 3 Kouchoukos NT, Masetti P.[circimaging.ahajournals.org]
  • Surgical treatment for Kommerell’s diverticulum. J Thorac Cardiovasc Surg . 2006 ; 131 : 574–578. Crossref Medline Google Scholar 3 Kouchoukos NT, Masetti P.[ahajournals.org]
  • CONCLUSIONS: Hybrid repair is a safe and effective surgical treatment option for Kommerell diverticulum. Selection of the specific type of intervention is based on patient anatomy and comorbid conditions.[ncbi.nlm.nih.gov]
  • Multidisciplinary contributions on medical treatment, radiation oncology, and surgery and anesthesia are included. Highlights include new material on minimally invasive procedures and thoroughly updated diagnostic and treatment information.[books.google.com]

Prognosis

  • Treatment and prognosis Given the rarity of this condition, there is no established management guideline.[radiopaedia.org]

Etiology

  • A possible etiology of the subclavian artery's anomalous origin would be an abnormality in regression of the fourth primitive aortic arch during embryonic development.[ncbi.nlm.nih.gov]
  • Dysphagia of unclear etiology ( dysphagia lusoria) is the most common presenting symptom of an enlarged anomalous subclavian artery and a Kommerell’s diverticulum (2).[journals.lww.com]
  • (Tex Heart Inst J 2002;29:109–12) Key words: Aorta, thoracic/abnormalities/embryology; esophageal stenosis/etiology; history of medicine, 20th cent.; subclavian artery/abnormalities Have you ever been asked by a medical colleague, “How do you spell Kommerell[ncbi.nlm.nih.gov]

Epidemiology

  • Epidemiological and demographic characteristics The frequency of ARSA varies throughout the world.[intechopen.com]
Sex distribution
Age distribution

Pathophysiology

  • […] the proximal descending aorta, the so-called Diverticulum of Kommerell (which was named for the German Radiologist, Burkhard Friedrich Kommerell (1901–1990), who discovered it in 1936). [5] [6] It is alternatively known as a lusorian artery. [1] [3] Pathophysiology[en.wikipedia.org]

Prevention

  • Prevent and plan for complications prior to a procedure thanks to a step-by-step approach to each procedure accompanied by relevant imaging studies.[books.google.com]
  • […] surgical approach was modified to reconstitute blood flow to the subclavian artery via transposition of its distal aspect to the carotid and is now considered standard of care. 8 In young patients, division of Kommerell diverticulum is warranted to prevent[jamanetwork.com]
  • A valve system in place here prevents the absorbed lymph from leaking back into the ISF, there is another system of semilunar valves that prevents back-flow of lymph along the lumen of the vessel.[wikivisually.com]
  • Usually found in pairs on opposite sides of the bladder, bladder diverticula are often surgically removed to prevent infection, rupture, or even cancer.[isnare.com]

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