First described in 1936, the diverticulum of Kommerell (DOK) is a dilatation
of the proximal segment of an aberrant subclavian artery. Appearing more
frequently in the left-sided aortic arch, the aberrant right subclavian artery
passes behind the esophagus toward the right arm, causing symptoms in the
minority of cases. Diagnosis is generally incidental with this pattern. When
symptomatic, dysphagia, respiratory symptoms, hoarseness, chest pain, and
upper limb ischemia are the most common complaints. Although debatable,
the origin of DOK is accepted as being degenerative or congenital. The
degenerative condition is normally associated with atherosclerosis and occurs
more frequently after the age of 50 years with no gender predominance.
Complications may be life threatening and are more commonly related to
the diverticulum aneurysm or when associated with aortic diseases such as
aneurysms or dissection. The authors present a case of a 67-year-old male
with a history of acute chest pain, neurological disturbances, and hypertensive
crisis. The diagnostic workup revealed an aortic arch aneurysm with
intramural hematoma and a diverticulum aneurysm of Kommerell. Treatment
was conservative at first. The patient presented a satisfactory outcome and
was referred to an outpatient clinic for follow up and further therapeutic
consolidation.
