The Clinical Spectrum of Kommerell’s Diverticulum in Adults with a Right-Sided Aortic Arch: A Case Series and Literature Overview

Abstract

Background: Kommerell’s diverticulum is a rare vascular anomaly characterized as an outpouch at the onset of an aberrant subclavian artery. In the variant of a right-sided aortic arch, the trachea and esophagus are enclosed dorsally by the arch. In the configuration of an aberrant left subclavian artery, a Kommerell’s diverticulum and persisting ductus arteriosus or ductal ligament enclose the lateral side, forming a vascular ring which may result in (symptomatic) esophageal or tracheal compression. Spontaneous rupture of an aneurysmatic Kommerell’s diverticulum has also been reported. Due to the rarity of this condition and underreporting in the literature, the clinical implications of a Kommerell’s diverticulum are not well defined. Case summary: We describe seven consecutive adult patients with a right-sided aortic arch and an aberrant course of the left subclavian artery (arteria lusoria), and a Kommerell’s diverticulum, diagnosed in our tertiary hospital. One patient had severe symptoms related to the Kommerell’s diverticulum and underwent surgical repair. In total, two of the patients experienced mild non-limiting dyspnea complaints and in four patients the Kommerell’s diverticulum was incidentally documented on a computed tomography (CT) scan acquired for a different indication. The size of the Kommerell’s diverticulum ranged from 19 × 21 mm to 30 × 29 mm. In the six patients that did not undergo surgery, a strategy of periodic follow-up with structural imaging was pursued. No significant growth of the Kommerell’s diverticulum was observed and none of the patients experienced an acute aortic syndrome to date. Discussion: Kommerell’s diverticulum in the setting of a right-sided aortic arch with an aberrant left subclavian artery is frequently associated with tracheal and esophageal compression and this may result in a varying range of symptoms. Guidelines on management of Kommerell’s diverticulum are currently lacking. This case series and literature overview suggests that serial follow-up is warranted in adult patients with a Kommerell’s diverticulum with small dimensions and no symptoms, however, that surgical intervention should be considered when patients become symptomatic or when the diameter exceeds 30 mm in the absence of symptoms.

A Rare, Relapsing Kommerell Diverticulum – A Case Report

“…Additionally, incidental findings in other diagnostic modalities such as chest x-ray or esophagogram in conjunction with symptoms compatible with esophageal compression should lead to the diagnostic suspicion of a KD [12] There are currently no specific guidelines regarding the treatment of this condition. Nonetheless, surgical interventions should be considered in symptomatic patients or in those with a diverticulum diameter bigger than 30 mm [13]. Surgical approach should be determined by the anatomic features of the KD, clinical presentation, comorbidities, past medical history and hemodynamic state to ensure an optimal treatment.…”

Successful treatment of patent ductus arteriosus accompanying right-sided aortic arch and aberrant left subclavian artery: a case report

“…7 Symptomatic patients and asymptomatic patients whose diameter of diverticulum exceeds 30 mm should be evaluated for surgery. 8 RAA accompanying ALSA and left-sided PDA are the most common subgroups of congenital vascular ring anomalies with an incidence of 0.04%. 9 Since the vascular ring surrounds the trachea and esophagus, it may cause compression symptoms such as dysphagia and dyspnoea at an early age.…”

Aortic Arch Variants and Anomalies: Embryology, Imaging Findings, and Clinical Considerations

“…Dorsal aortic arch segment persists as the retroesophageal diverticulum (Kommerell diverticulum), which gives rise to the ARSA ( Figure 9 ). 38) The right-sided ductus arteriosus (or ligamentum arteriosum) along with the opposite side’s left aortic arch complete a loose vascular ring surrounding the trachea and esophagus. 39) Kommerell diverticulum is found in 15–30% cases of LAA with ARSA, 40) and more commonly occurs in association with RAAs.…”