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Vascular ring with a Kommerell's diverticulum: Neonatal presentation with oesophageal symptoms
* For correspondence: bvenkatraman@gmail.com
This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
This article was originally published by Medknow Publications & Media Pvt Ltd and was migrated to Scientific Scholar after the change of Publisher.
A syndromic, term 2-day-old female neonate presented to the Narayana Multispeciality Hospital, Paediatric outpatient, in August 2013 with swallowing difficulty and drooling of saliva. Clinical evaluation revealed crepitations at lung bases. Clinical cardiovascular evaluation and subsequent micro-laryngobronchoscopy was normal. Echocardiography revealed moderate patent ductus arteriosus (PDA), atrial septal defect (ASD) and right aortic arch (RAA). CT angiography confirmed RAA with aberrant left subclavian, associated with a large Kommerell's diverticulum (KD) (Fig. 1A, B) Prominent posterior impression of oesophagus was demonstrated on the CT examination (arrow) (Fig. 1C). Three dimensional (3D) volume rendered CT images illustrated left ductal remnant (Fig. 2A) and large KD causing pressure on the oesophagus (Fig. 2B). Contrast oesophagography confirmed oesophageal impression, swallowing dysfunction and major gastro-oesophageal reflux. In view of syndromic association and oesophageal dysfunction addition to partial compression, patient was conservatively treated on anti-reflux management.
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A. Axial CT image showing right aortic arch(black arrow), kommerell's diverticulum (open arrow) and left ductal remnant(triangle). (B). Coronal CT image showing right aortic arch (black arrow) and left subclavian artery arising from kommerell's diverticulum (open arrow). (C). CT sagittal images showing localized oesophageal impression from kommerell's diverticulum (black arrow).
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A. Three dimentional volume rendered image viewed from above showing components of vascular ring, completed on left by ductal remnant (open arrow). (B). Ductal remnant and approximating outpouching from kommerell's diverticulum (green arrow) and main pulmonary artery (MPA) (white arrow) shown in sagittal surface rendered image (as also shown in A).
Acknowlegdment
Authors acknowledge neonatology consultant Dr Ravi Sharma for providing necessary clinical input and Dr Sejal Shah for providing echocardiography details.
