A 46-year-old woman visited our hospital due to progressive dysphagia and pain on swallowing over the past month. Esophagogastroduodenoscopy revealed extrinsic compression on the posterior side of the upper esophagus (22 cm from the incisors) (Picture 1). Contrast-enhanced computed tomography and angiography revealed a right-sided aortic arch with an aneurysmal diverticulum of the descending aorta, and the esophagus was observed to be fixed between the aneurysmal diverticulum and the trachea (Picture 2: arrows). The extrinsic esophageal compression was diagnosed to have been caused by Kommerell's diverticulum. Because of the progressive symptoms, resection of the aneurysm and aortic replacement were thus performed (Picture 3).
Picture 1.
Picture 2.
Picture 3.
A right-sided aortic arch with Kommerell's diverticulum is an uncommon congenital anomaly and may lead to dysphasia, cough, chest pain, and aneurysmal rupture (1,2). Although no indications for treatment have so far been established, surgical intervention is recommended in symptomatic patients. Although this is a rare case of dysphagia, it should be recognized that vascular anomalies may sometimes cause esophageal symptoms.
The authors state that they have no Conflict of Interest (COI).
References
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