Kommerell’s Diverticulum in an Aberrant Right Subclavian Artery: First Case Reported in a Male of Puerto Rican Descent

Abstract

A Kommerell’s diverticulum is a rare embryologic defect of the aortic arch. The majority of the patients having this defect present with dysphagia, dyspnea, and syncope, or a combination of any 2 or all 3. For symptomatic cases, surgical correction is always the standard of care. However, it is somewhat controversial what to do about asymptomatic cases. While surgery is almost always recommended, should asymptomatic patients undergo this procedure or not? Is it worth performing thoracic surgery for an anomaly whose nature is not really understood? In this case report, we describe a Kommerell diverticulum discovered incidentally in a 70-year old asymptomatic male. Surgery was not advisable for this patient; therefore, it was decided to manage him with surveillance. This is the first report in the Englishlanguage medical literature of a Kommerell diverticulum in a man of Puerto Rican descent. A thorough discussion of this rare anomaly follows; multimodality images of it are included at the end of this manuscript (see Figures 1–3).