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A 75-year-old woman was referred with a long history of dysphagia and wheezing. A chest radiograph revealed the presence of bilateral paratracheal stripes of abnormal appearance (fig 1).
Computed tomography angiography with 64 detectors (64-DCTA) of the chest revealed the presence of a right-sided aortic arch with an aberrant retro-oesophageal left subclavian artery arising from a Kommerell’s diverticulum (fig 2).
Kommerell’s diverticulum can occur in a number of anomalies of the aortic arch system.1 It may cause symptoms of tracheal or oesophageal compression, but not in all cases.3 In this patient the left subclavian artery arises from a right-sided aortic arch as the fourth branch passing behind the oesophagus to the left arm. 64-DCTA with isotropic submillimetre acquisition allowed high quality 3D volume-rendered images to be generated that readily showed this complex vascular anomaly.
A vascular malformation can mimic an upper mediastinal mass on the chest radiograph.
64-DCTA with 3D reconstruction is the gold standard for detecting vascular malformations in adults.
Competing interests: None.
Patient consent: Informed consent was obtained for publication of the person's details and the figures in this report.