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Clinical Images

What Lies Beneath: An Unexpected and Unusual Cause of Exertional Dyspnea

Avital Y. O’Glasser, MD, FACP; Kresimira M. Milas, MD, FACS

A 67-year-old woman presented with primary hyperparathyroidism.  She self-reported a history of asthma with long-standing exertional dyspnea.  On exam, lungs were clear to auscultation with a normal expiratory phase.

Chest x-ray demonstrated no airway thickening or hyperinflation but instead evidence of an aberrant right subclavian artery with mild compression of the posterior trachea (Figure 1).  Because of equivocal adenoma identification on ultrasound and Sestamibi scan, she underwent neck CT.  This revealed a large caliber contribution to the right subclavian artery arising from the distal aortic arch and following a retroesophageal aberrant course, forming a ring surrounding the trachea and esophagus (Figure 2).

What-lies-beneath-Figure-1.jpg

 

what-lies-beneath-Figure-2.jpg

 



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References:
1. Donnelly LF, Fleck RJ, Pacharn P, Ziegler MA, Fricke BL, Cotton RT. Aberrant subclavian arteries: cross-sectional imaging findings in infants and children referred for evaluation of extrinsic airway compression. AJR Am J Roentgenol. 2002 May;178(5):1269-74.
2. Strife JL, Bisset GS III, Burrows PE. Cardiovascular system. In: Kirks DR, ed. Practical pediatric radiology, 3rd ed. Philadelphia; Lippincot-Raven,1998:511–613.
3. Cinà CS, Althani H, Pasenau J, Abouzahr L. Kommerell's diverticulum and right-sided aortic arch: a cohort study and review of the literature. J Vasc Surg. 2004 Jan;39(1):131-9.
4. Kouchoukos NT, Masetti P.  Aberrant subclavian artery and Kommerell aneurysm: surgical treatment with a standard approach.  J Thorac Cardiovasc Surg. 2007 Apr;133(4):888-92.
5. Tanaka A, Milner R, Ota T. Kommerell's diverticulum in the current era: a comprehensive review. Gen Thorac Cardiovasc Surg. 2015 Jan 31.

Author Bios:

Avital Y. O’Glasser, MD, FACP - Division of Hospital Medicine, Department of Medicine, Oregon Health & Science University

Kresimira M. Milas, MD, FACS- Division of Surgical Oncology, Department of Surgery, Oregon Health & Science University



 

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