Hx: MVA, chest pain
Answer: Diverticulum of Kommerell
If you see a focal outpouching of the distal aortic arch + h/o trauma = THINK traumatic pseudoaneurysm! But lets look a bit closer here.
-No perioaortic stranding
-No wall thickening
-location = medial (retroesophageal)
-focal outpouching of the distal aortic arch at the origin of an aberrant subclavian artery (here artery is very small)
-can be aberrant L subclavian in setting of R aortic arch OR aberrant R subclavian in normal L aortic arch (here)
Coronal imaging is the key! Here you can see the diminutive aberrant R subclavian artery extending up to the right neck.
While acute aortic injury should be ALWAYS considered, with NO perioaortic stranding, NO evidence of aortic wall injury, & o/w NO thoracic trauma, this is c/w Kommerrell Diverticulum
-developmental variant -often asymptomatic (can yield esoph/trach obstruction if large)
- dilated prox aberrant subclavian artery w or w/o entire artery
If big can yield indentation on esophagram
Treatment? - if big (>30mm) consider TEVAR/arch replace