Season 9 Case 9

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)

Kommerrell Diverticulum

-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

Kommerrell Diverticulum

-developmental variant -often asymptomatic (can yield esoph/trach obstruction if large)

Imaging:

- 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