Fekadu Desalegn, Fantahun Suleyman, Alemayehu Abdi, Eshetu Yohannes, Assefa Gemechis, Hailu Samuel Sisay
Department of Surgery, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia.
Department of Radiology, Adama Comprehensive Specialized Hospital Medical College, Adama, Ethiopia.
Radiol Case Rep. 2024 Aug 8;19(10):4675-4681. doi: 10.1016/j.radcr.2024.06.090. eCollection 2024 Oct.
Right-sided aortic arch, first documented by Fioratti and Aglietti in 1763, is a rare variant of the thoracic vascular anatomy present in about 0.1% of the adult population. In half of these cases the left subclavian artery is also aberrant. The aberrant left subclavian artery usually originates from a conical dilatation near its origin from the aorta also known as "Kommerell's diverticulum." Fewer than 80 of these cases have been reported in the literature as far as our web search is concerned. It is usually asymptomatic and diagnosed incidentally during adulthood. We are presenting a 56 years old male patient presented with right side chest and shoulder pain of 1 week duration. The pain exacerbated with motion of the right upper extremity and radiates to his lower back. However, he had no history of cough, shortness of breath, syncope, and dysphagia. The vital signs were in normal range. Pulmonary and cardiovascular exam were unremarkable. The complete blood count (CBC), electrocardiogram (EKG), and echocardiography showed no abnormality. In the adult population a right-sided aortic arch with an aberrant left subclavian artery arising from Kommerell's diverticulum is a rare occurrence often asymptomatic unless aneurysmal disease or compression of mediastinal structures ensues. Even though it is rare and at times an incidental finding, the condition is clinically relevant because of the morbidity caused by the complications. We report a case of Kommerell's Diverticulum of an aberrant left subclavian artery in an adult patient with a right-sided aortic arch. Right-sided aortic arch with aberrant left subclavian artery arising from Kommerell's Diverticulum is quite rare and may remain asymptomatic. On times it may cause symptoms in adulthood often as a result of early atherosclerotic changes of the anomalous vessels, dissection, or aneurysmal dilatation with compression of adjacent structures causing dysphagia, dyspnea, cough, or chest pain. Even though there are no general guidelines for the management of this condition patients need to be informed about the nature and possible outcomes of their condition. Close follow up of asymptomatic patients is one option of management until there are situations which require consideration of surgical intervention.
右侧主动脉弓于1763年由菲奥拉蒂和阿涅利蒂首次记录，是一种罕见的胸段血管解剖变异，在约0.1%的成年人口中存在。在这些病例中，一半情况下左锁骨下动脉也异常。异常的左锁骨下动脉通常起源于其从主动脉发出处附近的一个锥形扩张，也称为“科默雷尔憩室”。就我们的网络搜索而言，文献中报道的此类病例不到80例。它通常无症状，在成年期偶然被诊断出来。我们报告一名56岁男性患者，出现右侧胸部和肩部疼痛，持续1周。疼痛在右上肢活动时加剧，并放射至下背部。然而，他没有咳嗽、气短、晕厥和吞咽困难的病史。生命体征在正常范围内。肺部和心血管检查无异常。全血细胞计数（CBC）、心电图（EKG）和超声心动图均未显示异常。在成年人群中，右侧主动脉弓伴起源于科默雷尔憩室的异常左锁骨下动脉是一种罕见情况，通常无症状，除非发生动脉瘤性疾病或纵隔结构受压。尽管这种情况罕见且有时是偶然发现，但由于并发症引起的发病率，该疾病具有临床相关性。我们报告一例成年患者右侧主动脉弓伴异常左锁骨下动脉的科默雷尔憩室病例。右侧主动脉弓伴起源于科默雷尔憩室的异常左锁骨下动脉非常罕见，可能无症状。有时它可能在成年期引起症状，通常是由于异常血管的早期动脉粥样硬化改变、夹层形成或动脉瘤性扩张，压迫相邻结构导致吞咽困难、呼吸困难、咳嗽或胸痛。尽管对于这种疾病的治疗没有通用指南，但需要告知患者其病情的性质和可能的结果。对无症状患者进行密切随访是一种治疗选择，直到出现需要考虑手术干预的情况。
