Presentation
Admitted with decreased GCS and increased oxygen requirement as well as elevated WBCs.
Patient Data
Type II right-sided aortic arch with aberrant left subclavian artery and Kommerell diverticulum (bullous origin of the aberrant left subclavian artery).
Bilateral lower lobe pulmonary consolidations are seen mainly posteriorly. This is associated with bilateral multiple scattered centrilobular infiltrates, more predominant at the left lung. The most likely possibility matching this appearance in this clinical situation is aspiration pneumonia. However, infection and less likely pulmonary edema are other possibilities.
Bilateral apical emphysematous changes with bullous formation at the right side.
The pulmonary trunks as well as the right and left main pulmonary arteries are patent showing adequate contrast opacification with no filling defects. Adequate opacification of the different segmental pulmonary artery branches of both lungs with no evidence of filling defects. Negative scan for acute pulmonary embolism.
No evidence of significantly enlarged mediastinal or hilar lymph nodes.
No pleural collections or pneumothorax.
Biventricular cardiac pacemaker in situ. Cardiomegaly noted.
Case Discussion
Type II right-sided aortic arch with aberrant left subclavian artery and Kommerell diverticulum (bullous origin of the aberrant left subclavian artery). The left common carotid artery arises first, followed by the right common carotid, right subclavian, and then left subclavian arteries. This is usually an incidental finding as in this case.