Vascular ring with a Kommerell's diverticulum: Neonatal presentation with oesophageal symptoms

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.

Close

Fig. 1 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).

Export to PPT

Close

Fig. 2 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).

Export to PPT