Saccular Kommerell aneurysm, a potential pitfall on MDCT imaging – A review of imaging features and potential mimics Hui Lin Wong, Charlene Jin Yee Liew,

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Presentation transcript:

Saccular Kommerell aneurysm, a potential pitfall on MDCT imaging – A review of imaging features and potential mimics Hui Lin Wong, Charlene Jin Yee Liew, Angeline Choo Choo Poh European Journal of Radiology Open Volume 4, Pages 89-94 (January 2017) DOI: 10.1016/j.ejro.2017.06.003 Copyright © 2017 The Authors Terms and Conditions

Fig. 1 78-year-old male with Kommerell aneurysm. Invasive catheter angiogram revealed mediastinal widening during cardiac catheterization. Note the tracheal deviation to the right (arrowheads) due to mass effect from the aneurysm. European Journal of Radiology Open 2017 4, 89-94DOI: (10.1016/j.ejro.2017.06.003) Copyright © 2017 The Authors Terms and Conditions

Fig. 2 78-year-old male with Kommerell aneurysm. (a) Frontal chest radiograph in the same patient demonstrating mediastinal widening with a smooth right paratracheal density (arrow) representing the aberrant right subclavian artery and tracheal deviation (arrowheads) caused by the Kommerell aneurysm. (b) axial, (c) coronal and (d) sagittal oblique post-IV contrast-enhanced MDCT demonstrates a saccular aneurysm (arrow) containing mural thrombus (dashed arrow), arising from the Kommerell diverticulum of an anomalous right subclavian artery (arrowheads) in a left-sided aortic arch. Hemopericardium was present, which was due to left ventricular rupture. European Journal of Radiology Open 2017 4, 89-94DOI: (10.1016/j.ejro.2017.06.003) Copyright © 2017 The Authors Terms and Conditions

Fig. 3 68-year-old male with a large Kommerell diverticulum. (a) Axial and (b) coronal post-IV contrast-enhanced MDCT showed a right-sided aortic arch with an aberrant left subclavian artery. There was fusiform dilatation of the origin of the aberrant left subclavian artery (arrows), in keeping with a Kommerell diverticulum. Note the absence of mural thrombus within the outpouching. European Journal of Radiology Open 2017 4, 89-94DOI: (10.1016/j.ejro.2017.06.003) Copyright © 2017 The Authors Terms and Conditions

Fig. 4 69-year-old male with a saccular thoracic aneurysm. (a) Axial-oblique, (b) coronal-oblique reformatted post-IV contrast enhanced MDCT and (c) three-dimensional (3D) volume-rendered projection shows a saccular outpouching (arrows) pointing left anterolaterally from the proximal descending thoracic aorta just after the origin of the left subclavian artery, in keeping with a saccular aneurysm. European Journal of Radiology Open 2017 4, 89-94DOI: (10.1016/j.ejro.2017.06.003) Copyright © 2017 The Authors Terms and Conditions

Fig. 5 74-year-old female with right-sided aortic arch and ductus diverticulum. (a) Axial and (b) coronal post-IV contrast-enhanced MDCT demonstrates a smooth focal bulge (arrows) in the aortic wall at the level of the aortic isthmus, just distal to the right subclavian artery, in keeping with a ductus diverticulum. European Journal of Radiology Open 2017 4, 89-94DOI: (10.1016/j.ejro.2017.06.003) Copyright © 2017 The Authors Terms and Conditions

Fig. 6 Schematic diagram of Kommerell aneurysm and mimics. The outpouching (arrows) may involve the aberrant right subclavian artery (ARSCA) or arise separately from the descending thoracic aorta. The shape of the outpouching is important; it may be either fusiform or saccular. Multiplanar reconstructions and three-dimensional (3D) volume-rendered reformations are crucial in making an accurate diagnosis (Diagram by Charlene Liew). European Journal of Radiology Open 2017 4, 89-94DOI: (10.1016/j.ejro.2017.06.003) Copyright © 2017 The Authors Terms and Conditions