Rare but relevant: Kommerell diverticulum and the weight of an anomaly – case report

Abstract Kommerell diverticulum is a rare congenital vascular anomaly with several anatomical variants. One uncommon presentation involves a right-sided aortic arch with an aberrant left subclavian artery arising from an ectatic origin, which may cause compressive symptoms and pose a risk of severe complications. We report a rare case of an elderly female patient, 67 years of age, who presented with constrictive anterior chest pain, predominantly expiratory dyspnoea, intermittent dysphagia to solid foods (dysphagia lusoria), and epigastralgia. Her medical history included asthma, diet-controlled type 2 diabetes mellitus, Biermer anaemia, gastroesophageal reflux disease, severe depressive disorder, and long-standing arterial hypertension with very high cardiovascular risk and target-organ involvement. Family history and laboratory findings were unremarkable. Electrocardiography revealed sinus bradycardia. Transthoracic echocardiography showed normal heart chambers, a mild left ventricular hypertrophy with preserved systolic function, aortic valve sclerosis with a mild transaortic gradient, and an interatrial septal aneurysm without shunt. Contrast-enhanced computed tomography angiography demonstrated a right-sided aortic arch with an aberrant left subclavian artery arising from a Kommerell diverticulum. This case underscores the clinical heterogeneity of Kommerell diverticulum since literature mostly reports paediatric cases, with a male predominance, and adult symptomatic cases remaining relatively uncommon. The coexistence of cardiovascular risk factors in our case raises management complexity. We wish to highlight how routine cardiological evaluation may underestimate a potentially life-threatening vascular anomaly, emphasising the role of advanced multimodal imaging in patients with atypical cardiovascular and gastrointestinal symptoms.