Kommerell diverticula occur in some anomalies of the aortic arch system. It usually refers to the bulbous configuration of the origin of an aberrant left subclavian artery in the setting of a right-sided aortic arch. However, it was originally described as a diverticular outpouching at the origin of an aberrant right subclavian artery with a left-sided aortic arch.
The prevalence of aberrant right and left subclavian arteries is approximately 0.7-2% and 0.04-0.4% of the population respectively 10. in 20-60% of people with aberrant subclavian arteries are associated with Kommerell’s diverticulum 10.
Kommerell diverticulum may be asymptomatic or cause symptoms of esophageal or tracheal obstruction. Presentation in childhood can often be with airway symptoms whereas dysphagia and chest discomfort can be more common in the adult presentation.
It is considered a developmental error with a remnant of the fourth dorsal aortic arch. Recent histological studies have suggested the presence of cystic medial necrosis in the diverticulum wall.
On chest radiographs, a small rounded density may be seen laterally towards the left of the trachea.
On a barium swallow, an impression can be seen from the left side of the esophagus simulating a double aortic arch.
Typically shows bulbous enlargement of the proximal subclavian artery at its origin from the aortic arch, posterior to the esophagus.
Treatment and prognosis
Given the rarity of this condition, there is no established management guideline. Options include aortic replacement or thoracic endovascular stent-graft replacement (TEVAR), and extra-anatomic bypass of the aberrant subclavian artery 6,7. Many consider surgical intervention once the diameter of the diverticulum orifice exceeds 30 mm, and/or the diameter of the descending aorta adjacent to the diverticulum exceeds 50 mm 8.
The major complications of Kommerell diverticulum are rupture or dissection 7.
History and etymology
It is named after Burckhard F Kommerell, a German radiologist (1901-1990) who first described it in 1936 8.
- 1. Dähnert W. Radiology Review Manual. Lippincott Williams & Wilkins. (2007) ISBN:0781766206. Read it at Google Books
- 2. Van son JA, Konstantinov IE. Burckhard F. Kommerell and Kommerell's diverticulum. Tex Heart Inst J. 2002;29 (2): 109-12. - Free text at pubmed - Pubmed citation
- 3. Welch TJ, Mckusick MA. Cardiovascular case of the day. Case 2: Aneurysm of aberrant right subclavian arising from diverticulum of Kommerell. AJR Am J Roentgenol. 1993;160 (6): 1313-4. AJR Am J Roentgenol (citation) - Pubmed citation
- 4. Carbone I, Sedati P, Galea N et-al. Right-sided aortic arch with Kommerell's diverticulum: 64-DCTA with 3D reconstructions. Thorax. 2008;63 (7): 662. Thorax (full text) - doi:10.1136/thx.2007.087072 - Pubmed citation
- 5. Berdon WE. Rings, slings, and other things: vascular compression of the infant trachea updated from the midcentury to the millennium-the legacy of Robert E. Gross, MD, and Edward B. D. Neuhauser, MD. Radiology. 2000;216 (3): 624-32. Radiology (full text) - Pubmed citation
- 6. Ota T, Okada K, Takanashi S et-al. Surgical treatment for Kommerell's diverticulum. J. Thorac. Cardiovasc. Surg. 2006;131 (3): 574-8. doi:10.1016/j.jtcvs.2005.10.012 - Pubmed citation
- 7. Knepper J, Criado E. Surgical treatment of Kommerell's diverticulum and other saccular arch aneurysms. J. Vasc. Surg. 2013;57 (4): 951-4. doi:10.1016/j.jvs.2012.10.094 - Pubmed citation
- 8. Tanaka A, Milner R, Ota T. Kommerell's diverticulum in the current era: a comprehensive review. (2015) General thoracic and cardiovascular surgery. 63 (5): 245-59. doi:10.1007/s11748-015-0521-3 - Pubmed
- 9. Cinà CS, Althani H, Pasenau J, Abouzahr L. Kommerell's diverticulum and right-sided aortic arch: a cohort study and review of the literature. (2004) Journal of vascular surgery. 39 (1): 131-9. doi:10.1016/j.jvs.2003.07.021 - Pubmed
- 10. Lee MW, Kim GH. Kommerell's diverticulum: a rare cause of esophageal subepithelial lesion. (2019) The Korean journal of internal medicine. 34 (6): 1392-1393. doi:10.3904/kjim.2018.102 - Pubmed
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