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- W3205656313 abstract "TOPIC: Cardiovascular Disease TYPE: Medical Student/Resident Case Reports INTRODUCTION: Kommerell diverticulum and aberrant subclavian artery are rare anomalies of the aortic branches in the upper mediastinum. We are presenting a case of a patient incidentally diagnosed with Kommerell diverticulum and aberrant left subclavian artery. CASE PRESENTATION: A 61-year-old male with hypertension and heart failure with preserved ejection fraction, presented to the cardiology clinic after overnight hospitalization for one episode of short-lasting midline chest and left arm pain while resting. He had a history of multiple episodes of non-exertional chest pain and exertional dyspnea, dysphagia and occasional wheezing. Stress test was negative for reversible perfusion defect and showed normal left ventricular ejection fraction. A recently performed transthoracic echocardiogram showed dilated aortic root and possible bicuspid aortic valve. Computed tomography angiogram (CTA) of aorta was performed for further evaluation. CTA aorta revealed a right sided aortic arch and aberrant left subclavian artery with a diverticulum of Kommerell. The patient is being closely followed up outpatient to prevent any potential complications. DISCUSSION: Aberrant left subclavian artery (ALSA) is seen in 0.05-0.1% population and a right aortic arch (aortic arch traversing over the right bronchus) is seen in 0.5% population. These anomalies can be associated with DiGeorge syndrome (deletion of chromosome 22q11.2) and conotruncal congenital heart disease. They can incompletely encircle the trachea and esophagus, creating a partial vascular ring and causing dyspnea, wheezing and dysphagia. In many cases, the ALSA arises from a vascular structure called Kommerell diverticulum (KD), most often derived from a remnant of the fourth aortic arch. KD is similar to the ascending aorta in diameter, and can compress the trachea and esophagus, producing the symptoms mentioned above. It can also cause complications like recurrent pneumonia, aortic dissection or fatal mediastinal hemorrhage from aneurysmal rupture of the diverticulum. CONCLUSIONS: Aneurysms of aberrant subclavian arteries need surgical and/or endovascular resection to decrease mortality. Hence, early diagnosis with close monitoring is crucial in patients with Kommerell diverticulum and aberrant subclavian artery. REFERENCE #1: Adams MT, Wilhelm M, Singh N, Andersen C. Right Aortic Arch With Kommerell Diverticulum: A Rare Cause of Dysphagia. JAMA Otolaryngol Head Neck Surg. 2014;140(6):560-562. doi:10.1001/jamaoto.2014.417 REFERENCE #2: Bhatt TC, Muralidharan CG, Singh G, Jain NK. Kommerell's diverticulum: A rare aortic arch anomaly. Med J Armed Forces India. 2016;72(Suppl 1):S80-S83. doi:10.1016/j.mjafi.2016.09.003 DISCLOSURES: No relevant relationships by surya Aedma, source=Web Response No relevant relationships by Pranav Mahajan, source=Web Response No relevant relationships by Riddhi Upadhyay, source=Web Response No relevant relationships by Karen Wiarda, source=Web Response" @default.
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- W3205656313 date "2021-10-01" @default.
- W3205656313 modified "2023-10-03" @default.
- W3205656313 title "KOMMERELL DIVERTICULUM: A RARE BUT POTENTIALLY LIFE THREATENING ANOMALY" @default.
- W3205656313 doi "https://doi.org/10.1016/j.chest.2021.07.247" @default.
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