You are here

Article Text

Article menu

Download PDFPDF

Images in cardiovascular medicine
Images of a vascular ring with a right aortic arch and Kommerell diverticulum obtained by three-dimensional CT
Free
  1. Toru Inami1,
  2. Yoshihiko Seino1,
  3. Kyoichi Mizuno2
  1. 1Department of Cardiology, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
  2. 2Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
  1. Correspondence to Dr Toru Inami, Department of Cardiology, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Inzai, Chiba 270-1694, Japan; t-inami{at}nms.ac.jp

https://doi.org/10.1136/heartasia-2012-010146

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    A 73-year-old man was referred for evaluation of ischaemic heart disease. During the evaluation a chest x-ray examination showed a right aortic arch (RAA) (figure 1). Three-dimensional CT showed a RAA with the Kommerell diverticulum (KD), from which arose an aberrant left subclavian artery (LSA) (figure 2A). The RAA separated branches arising in the following order: left common carotid artery, right common carotid artery, right subclavian artery (RSA) and aberrant LSA. Three-dimensional CT from the left posterior (figure 2B) and cephalic (figure 2C) view with resected branches clearly illustrated that the trachea was caught by the encircled space called the vascular ring, which comprised the KD and the RAA with residual ligamentum arteriosum to the descending aorta.

    Figure 1
    Figure 1

    Chest radiograph from a posteroanterior view showing the abnormal shape of the aorta.

    Figure 2
    Figure 2

    Three-dimensional reconstruction of CT image showing the right-sided aortic arch with aberrant left subclavian artery originating from a Kommerell diverticulum from (A) a front view; (B) a left posterior view. (C) Cephalic view with retro-oesophageal LSA. LCA, RCA, left, right carotid artery; LSA, RSA, left, right subclavian artery; MPA, main pulmonary artery.

    A KD was first described by Kommerell1 in 1936 as a rare congenital aneurysm of the origin of the aberrant subclavian artery. Development of KD with RSA occurs in 0.5–1.0% of the population, whereas RAA with LSA is extremely rare, occurring in 0.05–0.1% of the population.2 A cause of KD is an embryological abnormal regression of the primitive fourth aortic arch and ventral aortic root. Aneurysm of the KD may cause serious complications, including dissection and rupture. Three-dimensional CT is an important tool for the diagnosis and evaluation of complex vascular anomalies, and facilitates comprehension of anatomy by providing viewpoints in multiple orientations.

    Acknowledgments

    We are very grateful to Tsukasa Ueda in our Radiology Centre at Nippon Medical School Chiba Hokusoh Hospital for contributing to reconstruction of the image.

    References

    1. ↵
      1. Kommerell B
      . Compression of esophagus by an aberrant right subclavian artery (Arteria lusoria). Fortschr Geb Roentgenstrahlen 1936;54:590–5.
      OpenUrl
    2. ↵
      1. Tsukube T,
      2. Ataka K,
      3. Sakata M,
      4. et al
      . Surgical treatment of an aneurysm in the right aortic arch with aberrant left subclavian artery. Ann Thorac Surg 2001;71:1710–11.
      OpenUrlCrossRefPubMedWeb of Science

    Footnotes

    • Contributors TI, YS and KM contributed equally to the preparation and writing of the manuscript.

    • Competing interests None.

    • Patient consent Obtained.

    • Ethics approval Ethics committee at Nippon Medical School Chiba Hokusoh Hospital.

    • Provenance and peer review Not commissioned; internally peer reviewed.