Aortic aneurysm and diverticulum of Kommerell: a dreadful concomitance

Area of Science:

• Cardiovascular Medicine
• Vascular Surgery
• Radiology

Background:

• The diverticulum of Kommerell (DOK) is a rare dilatation of the proximal aberrant subclavian artery, typically associated with the left-sided aortic arch.
• It can be congenital or degenerative, often linked to atherosclerosis in older individuals.
• While frequently incidental, symptomatic presentations can include dysphagia, respiratory issues, and chest pain.

Observation:

• A 67-year-old male presented with acute chest pain, neurological disturbances, and hypertensive crisis.
• Diagnostic imaging revealed an aortic arch aneurysm with intramural hematoma and a diverticulum aneurysm of Kommerell.
• The patient's condition was initially managed conservatively.

Findings:

• The case demonstrates a complex presentation of diverticulum of Kommerell associated with significant aortic pathology.
• Conservative management led to a satisfactory initial outcome.
• The patient was referred for ongoing outpatient follow-up and therapeutic planning.

Implications:

• This case underscores the importance of considering DOK in the differential diagnosis of complex cardiovascular presentations, especially when associated with aortic disease.
• Conservative management may be a viable initial strategy for select patients with DOK and associated aneurysms.
• Further research into the long-term outcomes and optimal management strategies for symptomatic DOK is warranted.