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KOMMERELL’S DIVERTICULUM |
Aortic diverticulum or Kommerell’s
diverticulum is a rare aortic congenital anomaly that
is produced as a result of the aberrant origin of the left subclavian artery, that arises of right arch aortic as a fourth branches
and passes behind of the esophagus to the left shoulder instead of arising from
the right brachiocephalic artery.
This anomaly is the result of regression in the 4th left aortic arch between
the left carotid and left subclavian arteries.
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The left subclavian
artery arises from an aortic pouch or diverticulum at
the junction of the right aortic arch and the right descending aorta and passes
obliquely upward, behind the esophagus, toward the left arm.
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This anomaly can be
isolated or occur in a number of anomalies of the aortic arch.
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The vast majority of
patients with a vascular ring present with symptoms in infancy or very early in
childhood. However, a small number of patients do not manifest symptoms until
later in life, and others remain entirely asymptomatic
Common symptoms include laryngeal stridor, cyanosis,
respiratory distress, apnea, and/or a characteristic high-pitched, brassy
cough. Additional findings include a history of asthma, recurrent pneumonia, or
evidence of dysphagia or difficulty with feedings. In
some cases, airway symptoms are worsened or aggravated by feedings. Intercostal retractions during respiration are observed in
some infants with severe obstruction.
When is associated with a right aortic arch, there is a 5 – 10% incidence
of accompanying congenital heart diseases. These include tetralogy
of Fallot. Atrial septal defect, ventricular septal
defect and coarctation of the aorta.
REFERENCES |