Thread by @RyanChristieMD

#WetreadCoW Case 9

Hx: MVA, chest pain

Please answer with professionally appropriate gif responses only. No spoilers! wetread.org #FOAMrad #FOAMed #radres #errad #chestrad

#WetreadCoW Case 9 Answer: Diverticulum of Kommerell

Focal outpouching of the distal aortic arch + h/o trauma ➡️ think traumatic PSA⭐️, but lets look a bit closer here

No perioaortic stranding
No wall thickening
location = medial (retroesophageal 🤔)
#FOAMrad #radres #chestrad

Kommerrell Diverticulum

-focal outpouching of the distal aortic arch at the origin of an aberrant subclavian artery (here artery is very small)

-can be aberrant L subcl in setting of R aortic arch OR aberrant R subcl in normal L aortic arch (here) #FOAMed #FOAMrad #radres

Here coronal is 🔑! You can see the diminutive aberrant R subcl a extending up to the R neck.

While acute aortic injury should be ALWAYS considered ⭐️, without perioaortic stranding, no evidence of aortic wall injury,& o/w no thoracic trauma, this is c/w Kommerrell Diverticulum

Kommerrell Diverticulum

-developmental variant
-often asymptomatic (can ➡️ esoph/trach obstruction if large)

Imaging:
- dilated prox aberrant subclavian artery w or w/o entire artery
-Big➡️ indentation on esophagram

-Trt? - if big (>30mm) ?TEVAR/arch replace
#FOAMed #radres