右位主动脉弓伴起源于Kommerell憩室的迷走左锁骨下动脉的影像表现

Imaging findings of right aortic arch with aberrant left subclavian artery arising from Kommerell’s diverticulum

目的探讨右位主动脉弓伴起源于Kommerell憩室的迷走左锁骨下动脉的影像学表现及其临床意义。方法回顾性分析25例右位主动脉弓伴起源于Kommerell憩室的迷走左锁骨下动脉患者的影像学资料,全部患者行胸片和胸部CT检查,其中4例患者行胸主动脉CTA检查,1例行胸腹主动脉CTA和MRA检查。结果25例患者胸部平片见右位主动脉弓,12例见"双主动脉弓",9例误诊为纵隔病变。CT和MR能显示左锁骨下动脉起源于主动脉弓降段左侧壁,起始段膨大形成Kommerell憩室,迷走左锁骨下动脉横跨食管后方,"双主动脉弓"的左弓为膨大的Kommerell憩室及其远侧的迷走左锁骨下动脉。2例左锁骨下动脉近段动脉硬化并形成动脉瘤。1例患者偶觉吞咽不适。结论右位主动脉弓伴起源于Kommerell憩室的迷走左锁骨下动脉是一种罕见的先天变异,胸片容易误诊为纵隔病变,CT和MR能明确诊断并显示变异血管继发病变。正确认识此变异,有助于避免误诊。

Objective To discuss the imaging findings and clinical value of right aortic arch(RAA)with aberrant left subclavian artery(LASA)arising from Kommerell’s diverticulum(KD).Methods Imaging findings and clinical data of 25 patients with RAA and LASA arising from KD were retrospectively analysed.All cases were examined with chest X-ray and CT scan,4 of them underwent CTA examination of thoracic aorta and 1 underwent CTA and MRA examination of thoracic and abdominal aorta.Results 25 patient’s chest X-ray can display the RAA,of whom 12 can show the"double aortic arch",9 cases were misdiagnosed as mediastinal lesion by chest X-ray.LASA of 25 patients originated from the left side of the descending aortic arch and the KD was the dilated origin of aberrant subclavian artery or proximal descending aorta on CT and MRI image.LASA usually crossed behind the esophagus.The double aortic arch was KD and LASA.2 case were found LASA with arteriosclerosis and aneurysms,1 patient fell dysphagia in sometime.Conclusion RAA and LASA arising from KD was a congenital anatomic variation.Chest X-ray may be easy to misdiagnose as mediastinal lesion.CT and MR examination can diagnose and display the pathological changes of variation blood vessel.In order to avoid misdiagnosis,we must understand the imaging findings of this variation.