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      A Rare Case of Submassive Pulmonary Embolism with a Right Aberrant Subclavian Artery and Thrombosed Kommerell Diverticulum

      case-report

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          Abstract

          An 81-year-old man presented with shortness of breath and was referred to our hospital with suspected acute pulmonary embolism. Enhanced computed tomography revealed a right aberrant subclavian artery with a thrombosed Kommerell diverticulum (KD), as well as deep vein thrombosis in the left leg and bilateral pulmonary artery thrombosis. Thrombosis in the KD disappeared after one month of anticoagulation treatment with rivaroxaban. Thrombosis of a KD is a rare condition that may cause distal emboli and subclavian steal syndrome, although this syndrome was not present in this case. Rivaroxaban is an effective anticoagulant for treating thrombosis of a KD.

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          Burckhard F. Kommerell and Kommerell's diverticulum.

          Igor E. Konstantinov, Melissa A. Linden (2001)
          Burckhard Friedrich Kommerell's scholarly description of the aortic diverticulum that bears his name was published in 1936. In the international literature, however the name of Kommerell survives only as an eponym. We present biographical information about Kommerell, as supplied by family members, and comment on the surgical relevance of his 1936 report.
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            Contemporary Surgical Approaches and Outcomes in Adults With Kommerell Diverticulum

            Karen Kim, Richard P Cambria, Eric Isselbacher … (2014)
            Surgery in patients with Kommerell diverticulum (KD) is controversial. Although the presence of symptoms is an accepted indication, the KD itself may be a risk factor for dissection and rupture, although size criteria for operation are undefined.
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              Operation for aortic arch anomalies.

              J Richardson, D Doty, N P Rossi … (1981)
              Forty-two patients with aortic arch anomalies resulting in tracheoesophageal compression were treated during the period 1948 through 1978. These anomalies are important causes of upper respiratory and esophageal obstruction in babies and small children and can be corrected safely with excellent relief of symptoms. Nineteen patients (45%) had a right aortic arch with a ligamentum arteriosum, 17 patients (40%) had double aortic arches, and 6 patients (15%) had aberrant right subclavian arteries. Other associated congenital malformation and mental retardation were seen in 15 patients (36%). Diagnosis was accurately made in 38 patients (90%) by barium esophagogram. Basic surgical principles include exposure through a left thoracotomy, complete identification of the aortic arch anatomy, and division of the constricting ring. Surgical treatment resulted in 2 deaths (5%), and 1 patient died late. Early postoperative respiratory complications were common. All survivors were relieved of their symptoms late (median, 94 months) postoperatively.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Intern Med
                Journal ID (iso-abbrev): Intern. Med
                Title: Internal Medicine
                Publisher: The Japanese Society of Internal Medicine
                ISSN (Print): 0918-2918
                ISSN (Electronic): 1349-7235
                Publication date (Electronic): 23 April 2020
                Publication date (Print): 1 August 2020
                Volume: 59
                Issue: 15
                Pages: 1861-1865
                Affiliations
                [1 ]Department of Cardiology, Fukuoka University School of Medicine, Japan
                Author notes

                Correspondence to Dr.　Tomo Komaki, tomokomaki1981@ 123456yahoo.co.jp

                Article
                DOI: 10.2169/internalmedicine.4495-20
                PMC ID: 7474989
                PubMed ID: 32321896
                SO-VID: 6afa4fb9-850d-4b6f-a911-7a5f9841ae15
                Copyright © Copyright © 2020 by The Japanese Society of Internal Medicine
                License:

                The Internal Medicine is an Open Access journal distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. To view the details of this license, please visit ( https://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Date received : 17 January 2020
                Date accepted : 4 March 2020
                Categories
                Subject: Case Report

                Keywords: a thrombosed kommerell diverticulum,pulmonary embolism,a strong hypercoagulable state,rivaroxaban
                Data availability:
                Keywords: a thrombosed kommerell diverticulum, pulmonary embolism, a strong hypercoagulable state, rivaroxaban

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