Right-Sided Aortic Arch with Aberrant Left Subclavian Artery–Kommerell’s Diverticulum: a rare case report from Enat Multi specialty clinic, North West Ethiopia, 2025

Right-Sided Aortic Arch with Aberrant Left Subclavian Artery–Kommerell’s Diverticulum: a rare case report from Enat Multi specialty clinic, North West Ethiopia, 2025 | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Right-Sided Aortic Arch with Aberrant Left Subclavian Artery–Kommerell’s Diverticulum: a rare case report from Enat Multi specialty clinic, North West Ethiopia, 2025 Yefiru Andualem Mitiku, Nibrete Molla, Tadesse Fekad, Tamiru Alene This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6727859/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 11 You are reading this latest preprint version Abstract Introduction : Kommerell's diverticulum with a right-sided aortic arch is a rare congenital anomaly. It may be detected incidentally or present with symptoms due to compression of mediastinal structures. Rarely, it can present with rupture or aortic dissection. Diagnosis is confirmed through computed tomography (CT) or magnetic resonance angiography (MRA). Surgery is typically reserved for symptomatic cases. We report a case of a right-sided aortic arch with aberrant subclavian artery and Kommerell’s diverticulum confirmed by CT in a young woman presenting with chronic cough and retrosternal discomfort. Case Presentation: A 28-year-old woman presented with a 9-month history of dry cough, dyspnea, and dysphagia that began during her third months of pregnancy. Examination revealed differential blood pressures between arms. Chest X-ray showed a right-sided aortic arch displacing the trachea leftward. CT angiography confirmed a right-sided aortic arch with aberrant left subclavian artery originating from a Kommerell’s diverticulum. She was managed symptomatically and remains under follow-up. Conclusion: Right-sided aortic arch with Kommerell’s diverticulum may be asymptomatic or present with respiratory and gastrointestinal symptoms. Basic investigations like chest X-ray can aid in early suspicion. It should be considered in the differential diagnosis of chronic cough, dyspnea, and dysphagia. Aortic anomalies Right-sided aortic arch Kommerell’s diverticulum Case report Figures Figure 1 Figure 2 Figure 3 Introduction Congenital anomalies of the aorta often involve the aortic arch and its branches. When anomalies create a vascular ring or compression around the trachea or esophagus, they may cause symptoms such as dysphagia, stridor, or cough. Right-sided aortic arch is a rare finding, occurring in approximately 0.05% of the population [ 1 ]. In 35–50% of cases, it is associated with an aberrant subclavian artery arising from a Kommerell’s diverticulum [ 2 ]. Kommerell’s diverticulum (KD) results from failed regression of the primitive fourth dorsal aortic arch during embryonic development [ 3 ]. KD may be asymptomatic and discovered incidentally or present with compressive symptoms like dysphagia (dysphagia lusoria), cough, and dyspnea. Rarely, it may lead to rupture or aortic dissection [ 4 – 6 ]. Diagnosis relies on CT or MR angiography. Surgical intervention is recommended for symptomatic cases or for those at risk of complications. Here, we present a case of right-sided aortic arch with Kommerell’s diverticulum presenting during pregnancy. Case Presentation A 28-year-old female patient presented with a 9-month history of a dry cough, shortness of breath, and dysphagia to solid foods. These symptoms began around the third month of her pregnancy. The patient was Gravida III, Para II, and had an uncomplicated delivery. She had no known history of cardiac or renal disease and no history of smoking. On physical examination, her left brachial blood pressure was 110/70 mmHg, and the right brachial blood pressure was 90/60 mmHg. Her pulse rate was 90 beats per minute on the right radial artery and 100 beats per minute on the left radial artery, which was feeble and difficult to palpate. No bruits were auscultated over the carotid arteries, and there was no palpable mass in the lateral neck. Peripheral pulses were palpable, and auscultation of the heart revealed no murmurs or gallops. Findings in other organ systems were normal. Laboratory results, including complete blood count, blood glucose, and lipid profile, were within normal limits. A chest X-ray (posteroanterior view) revealed the aortic knuckle positioned to the right of the trachea, which mildly displaced the trachea leftward, causing mild narrowing of the tracheal lumen. Figure 1 A contrast-enhanced chest CT scan confirmed the presence of a right-sided aortic arch with an aberrant left subclavian artery originating from a Kommerell’s diverticulum. The aberrant left subclavian artery passed posterior to the esophagus, causing compression and mild luminal narrowing of both the esophagus and the trachea. Figure 2 The patient was diagnosed with dyspepsia and is currently under follow-up care. Discussion Right-sided aortic arch (RAA) is a rare congenital anomaly, resulting from the persistence of the right fourth brachial arch during embryogenesis. It is often associated with other congenital heart defects, particularly in type I right-sided aortic arches, such as Tetralogy of Fallot or truncus arteriosus. However, RAA with an aberrant subclavian artery and Kommerell’s diverticulum (type II) is typically asymptomatic and can be detected incidentally on imaging studies. Kommerell’s diverticulum, first described by Kommerell in 1936, is an aneurysmal dilation of the aortic wall at the origin of the aberrant subclavian artery. This anomaly occurs in both right- and left-sided aortic arches, but it is most commonly associated with a right-sided arch with an aberrant left subclavian artery. It can cause compression of the trachea and esophagus, leading to symptoms such as dysphagia, cough, and dyspnea. In rare cases, complications such as rupture or aortic dissection may occur [ 1 – 6 ]. In the case presented, the patient exhibited mild differential blood pressure (8 mmHg), which could be attributed to atherosclerotic changes in the distal subclavian artery. The aberrant subclavian artery passed posterior to the esophagus, resulting in compression and mild narrowing of both the trachea and esophagus. Despite this, the patient did not experience significant symptoms related to the abnormal vascular anatomy. This case represents a type II right-sided aortic arch, which remains asymptomatic in the majority of cases. Symptoms typically appear after the age of 40 due to atherosclerotic changes, which can further increase the risk of complications such as aneurysm rupture or dissection. In our case, the patient was diagnosed early through imaging, which is crucial for managing symptomatic cases or preventing future complications. Conclusion Right-sided aortic arch with Kommerell’s diverticulum is a rare congenital anomaly, which may or may not be symptomatic. Basic diagnostic tools, such as chest X-ray and CT angiography, are valuable for early diagnosis. Clinicians should consider this anomaly in the differential diagnosis of patients presenting with chronic cough, dysphagia, or dyspnea, especially if there is a history of abnormal vascular findings on imaging. While surgery is indicated for symptomatic cases, many patients can be managed conservatively with appropriate follow-up. Abbreviations CT_ Computed Tomography; Fig._ Figure; KD_ Kommerell’s diverticulum KD; MRA_ Magnetic Resonance Angiography; RAA_ Right-sided aortic arch. Declarations Data availability statement : All data generated or analyzed during this case report are included in this published article. Additional supporting information, such as imaging findings and patient data, may be available from the corresponding author upon reasonable request, in compliance with institutional and ethical guidelines. Ethics approval and consent to participate : This study was conducted after getting ethical clearance from Enat Multispecialty Clinic on the date 21/02/2025 with protocol number 010101053/17. After getting the ethical clearance the patient herself was asked about the reporting of the case as publication and. She was informed as it doesn’t cause any harm. Consent for publication: Written informed consent for publication of the patient’s clinical details and/or identifying images was obtained from her. Copies of the consent forms are available for review by the Editor upon request. Availability of data and materials : All the data supporting the results were indicated in the manuscript. Competing interest: The authors declare that they have no conflicts of interest. Funding : No financial funding was received for this study. Authors’ contributions : YA &TA – Involved in history taking, physical diagnosis, participated in writing proposal and taking consent from the patient; NM &TF –In reading and compiling the CT scan and X-ray reports. Acknowledgment: The authors give great thank for Enat Multi Specialty Clinic Board for the approval of the ethical clearance. Next, we also thank Mrs.Firehiwot Fekadu for her cooperation. References Felson B, Palayew M. The right-sided aortic arch and its clinical implications. J Thorac Cardiovasc Surg. 1963;45:69-81. Stewart AL, Frazier OH, Kirklin JW. Aortic arch anomalies. Arch Surg. 1964;88:1024-1036. Kommerell B. The congenital anomaly of the aorta in relation to the subclavian artery. Radiology. 1936;27:622-631. Yu Z, Deng L, Xu D, et al. Clinical presentation and management of Kommerell's diverticulum: a review. J Vasc Surg. 2020;72(2):530-536. Duran C, Urkmez E, Berker D, et al. Kommerell's diverticulum in a right-sided aortic arch: a case report and review of literature. Cardiovasc Surg. 2011;25(1):26-29. Janke C, Kausch A, Lange C, et al. Aortic dissection in a patient with Kommerell’s diverticulum and right-sided aortic arch. Eur J Cardiothorac Surg. 2015;47(5):864-866. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 04 Mar, 2026 Reviews received at journal 25 Jun, 2025 Reviews received at journal 24 Jun, 2025 Reviews received at journal 15 Jun, 2025 Reviewers agreed at journal 14 Jun, 2025 Reviewers agreed at journal 12 Jun, 2025 Reviewers agreed at journal 12 Jun, 2025 Reviewers invited by journal 12 Jun, 2025 Editor assigned by journal 02 Jun, 2025 Submission checks completed at journal 30 May, 2025 First submitted to journal 30 May, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6727859","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":471396855,"identity":"bc1bcf75-402b-4f56-98b9-11cab4c2553a","order_by":0,"name":"Yefiru Andualem Mitiku","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAx0lEQVRIiWNgGAWjYFACxgcHgKQciHngAXFamA1AWozBWhKI1QIiExtAJFFaDI43Mx6ubLNLnx92+CHQFjs53QZCWs4cZjh4ti05d+PtNAOglmRjswOEtNzIP3CwsY05d+PsBJCWA4nbCGq5/5gBqKU+3XB2+gcitdxgBmk5nCAvnUOkLZJnkhkONpw7brhBOqfgQIIBEX7hO36Y+WNDWbW8/Oz0zR8+VNjJEdSiAFMAjlAGAwLKQUC+AZ0xCkbBKBgFowAdAADJZEvYamxZcwAAAABJRU5ErkJggg==","orcid":"","institution":"Injibara University","correspondingAuthor":true,"prefix":"","firstName":"Yefiru","middleName":"Andualem","lastName":"Mitiku","suffix":""},{"id":471396856,"identity":"0ca9872a-8a4b-4c92-8116-c0ab308dbc03","order_by":1,"name":"Nibrete Molla","email":"","orcid":"","institution":"Agew Midher General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Nibrete","middleName":"","lastName":"Molla","suffix":""},{"id":471396857,"identity":"30e2cd5c-d830-4d31-b0b5-5e8d1c38491a","order_by":2,"name":"Tadesse Fekad","email":"","orcid":"","institution":"Injibara General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Tadesse","middleName":"","lastName":"Fekad","suffix":""},{"id":471396858,"identity":"f967a762-b66a-43fb-9d8d-48088796da0f","order_by":3,"name":"Tamiru Alene","email":"","orcid":"","institution":"Injibara University","correspondingAuthor":false,"prefix":"","firstName":"Tamiru","middleName":"","lastName":"Alene","suffix":""}],"badges":[],"createdAt":"2025-05-22 21:08:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6727859/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6727859/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":84918775,"identity":"1e58847e-4756-472c-b585-3a53c8fa18ef","added_by":"auto","created_at":"2025-06-18 19:29:03","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":20813,"visible":true,"origin":"","legend":"\u003cp\u003eStandard posterior anterior chest x ray of a patient showing aortic knuckle located to right of trachea and it mildly push the trachea to the left with mild narrowing of tracheal lumen seen at Enat Multi specialty clinic, 2025.\u003c/p\u003e","description":"","filename":"Fig.1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6727859/v1/2f29d60bf90d51f211b0d67b.jpg"},{"id":84920240,"identity":"95faf039-96d8-4939-91cd-f23156d55b36","added_by":"auto","created_at":"2025-06-18 19:37:03","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":29584,"visible":true,"origin":"","legend":"\u003cp\u003eStandard pre and post contrast axial chest computed tomography scan with multi planar reconstruction seen at Enat Multi specialty clinic, 2025.\u003c/p\u003e","description":"","filename":"Fig.2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6727859/v1/58d815b7ffc4c38835b9e81b.jpg"},{"id":84918779,"identity":"0485a40a-504b-479c-b1cd-62826755e428","added_by":"auto","created_at":"2025-06-18 19:29:03","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":52264,"visible":true,"origin":"","legend":"\u003cp\u003eAdditional Figure 2 image. No legend is provided with this image.\u0026nbsp;\u003c/p\u003e","description":"","filename":"Fig.2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6727859/v1/33bb2455fa693b19dd3ddfb5.jpg"},{"id":84921174,"identity":"1a30c7ed-58f2-4639-9d5e-b1425f0d043d","added_by":"auto","created_at":"2025-06-18 19:45:07","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":468751,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6727859/v1/89b970a5-ce3b-4f52-abc4-6163abe9f6a6.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Right-Sided Aortic Arch with Aberrant Left Subclavian Artery–Kommerell’s Diverticulum: a rare case report from Enat Multi specialty clinic, North West Ethiopia, 2025","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCongenital anomalies of the aorta often involve the aortic arch and its branches. When anomalies create a vascular ring or compression around the trachea or esophagus, they may cause symptoms such as dysphagia, stridor, or cough. Right-sided aortic arch is a rare finding, occurring in approximately 0.05% of the population [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In 35\u0026ndash;50% of cases, it is associated with an aberrant subclavian artery arising from a Kommerell\u0026rsquo;s diverticulum [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eKommerell\u0026rsquo;s diverticulum (KD) results from failed regression of the primitive fourth dorsal aortic arch during embryonic development [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eKD may be asymptomatic and discovered incidentally or present with compressive symptoms like dysphagia (dysphagia lusoria), cough, and dyspnea. Rarely, it may lead to rupture or aortic dissection [\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDiagnosis relies on CT or MR angiography. Surgical intervention is recommended for symptomatic cases or for those at risk of complications. Here, we present a case of right-sided aortic arch with Kommerell\u0026rsquo;s diverticulum presenting during pregnancy.\u003c/p\u003e"},{"header":"Case Presentation","content":"\u003cp\u003eA 28-year-old female patient presented with a 9-month history of a dry cough, shortness of breath, and dysphagia to solid foods. These symptoms began around the third month of her pregnancy. The patient was Gravida III, Para II, and had an uncomplicated delivery. She had no known history of cardiac or renal disease and no history of smoking.\u003c/p\u003e \u003cp\u003eOn physical examination, her left brachial blood pressure was 110/70 mmHg, and the right brachial blood pressure was 90/60 mmHg. Her pulse rate was 90 beats per minute on the right radial artery and 100 beats per minute on the left radial artery, which was feeble and difficult to palpate. No bruits were auscultated over the carotid arteries, and there was no palpable mass in the lateral neck. Peripheral pulses were palpable, and auscultation of the heart revealed no murmurs or gallops. Findings in other organ systems were normal.\u003c/p\u003e \u003cp\u003eLaboratory results, including complete blood count, blood glucose, and lipid profile, were within normal limits.\u003c/p\u003e \u003cp\u003eA chest X-ray (posteroanterior view) revealed the aortic knuckle positioned to the right of the trachea, which mildly displaced the trachea leftward, causing mild narrowing of the tracheal lumen. Figure\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eA contrast-enhanced chest CT scan confirmed the presence of a right-sided aortic arch with an aberrant left subclavian artery originating from a Kommerell\u0026rsquo;s diverticulum. The aberrant left subclavian artery passed posterior to the esophagus, causing compression and mild luminal narrowing of both the esophagus and the trachea. Figure\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe patient was diagnosed with dyspepsia and is currently under follow-up care.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eRight-sided aortic arch (RAA) is a rare congenital anomaly, resulting from the persistence of the right fourth brachial arch during embryogenesis. It is often associated with other congenital heart defects, particularly in type I right-sided aortic arches, such as Tetralogy of Fallot or truncus arteriosus. However, RAA with an aberrant subclavian artery and Kommerell\u0026rsquo;s diverticulum (type II) is typically asymptomatic and can be detected incidentally on imaging studies.\u003c/p\u003e \u003cp\u003eKommerell\u0026rsquo;s diverticulum, first described by Kommerell in 1936, is an aneurysmal dilation of the aortic wall at the origin of the aberrant subclavian artery. This anomaly occurs in both right- and left-sided aortic arches, but it is most commonly associated with a right-sided arch with an aberrant left subclavian artery. It can cause compression of the trachea and esophagus, leading to symptoms such as dysphagia, cough, and dyspnea. In rare cases, complications such as rupture or aortic dissection may occur [\u003cspan additionalcitationids=\"CR2 CR3 CR4 CR5\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn the case presented, the patient exhibited mild differential blood pressure (8 mmHg), which could be attributed to atherosclerotic changes in the distal subclavian artery. The aberrant subclavian artery passed posterior to the esophagus, resulting in compression and mild narrowing of both the trachea and esophagus. Despite this, the patient did not experience significant symptoms related to the abnormal vascular anatomy. This case represents a type II right-sided aortic arch, which remains asymptomatic in the majority of cases. Symptoms typically appear after the age of 40 due to atherosclerotic changes, which can further increase the risk of complications such as aneurysm rupture or dissection. In our case, the patient was diagnosed early through imaging, which is crucial for managing symptomatic cases or preventing future complications.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eRight-sided aortic arch with Kommerell\u0026rsquo;s diverticulum is a rare congenital anomaly, which may or may not be symptomatic. Basic diagnostic tools, such as chest X-ray and CT angiography, are valuable for early diagnosis. Clinicians should consider this anomaly in the differential diagnosis of patients presenting with chronic cough, dysphagia, or dyspnea, especially if there is a history of abnormal vascular findings on imaging. While surgery is indicated for symptomatic cases, many patients can be managed conservatively with appropriate follow-up.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCT_ Computed Tomography; Fig._ Figure; KD_ \u0026nbsp;Kommerell\u0026rsquo;s diverticulum KD; MRA_ Magnetic Resonance Angiography; \u0026nbsp;RAA_ Right-sided aortic arch.\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eData availability statement\u003c/strong\u003e: All data generated or analyzed during this case report are included in this published article. Additional supporting information, such as imaging findings and patient data, may be available from the corresponding author upon reasonable request, in compliance with institutional and ethical guidelines.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003eThis study was conducted after getting ethical clearance from Enat Multispecialty Clinic on the date 21/02/2025 with protocol number 010101053/17. After getting the ethical clearance the patient herself was asked about the reporting of the case as publication and. She was informed as it doesn\u0026rsquo;t cause any harm.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eWritten informed consent for publication of the patient\u0026rsquo;s clinical details and/or identifying images was obtained from her. Copies of the consent forms are available for review by the Editor upon request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e All the data supporting the results were indicated in the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interest:\u0026nbsp;\u003c/strong\u003eThe authors declare that they have no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e: No financial funding was received for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions :\u003c/strong\u003eYA \u0026amp;TA \u0026ndash; Involved \u0026nbsp;in history taking, physical diagnosis, participated in writing proposal and taking consent from the patient; NM \u0026amp;TF \u0026ndash;In reading and compiling the CT scan and X-ray reports.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgment:\u0026nbsp;\u003c/strong\u003eThe authors give great thank for Enat Multi Specialty Clinic Board for the approval of the ethical clearance. Next, we also thank Mrs.Firehiwot Fekadu for her cooperation.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eFelson B, Palayew M. The right-sided aortic arch and its clinical implications. J Thorac Cardiovasc Surg. 1963;45:69-81.\u003c/li\u003e\n\u003cli\u003eStewart AL, Frazier OH, Kirklin JW. Aortic arch anomalies. Arch Surg. 1964;88:1024-1036.\u003c/li\u003e\n\u003cli\u003eKommerell B. The congenital anomaly of the aorta in relation to the subclavian artery. Radiology. 1936;27:622-631.\u003c/li\u003e\n\u003cli\u003eYu Z, Deng L, Xu D, et al. Clinical presentation and management of Kommerell\u0026apos;s diverticulum: a review. J Vasc Surg. 2020;72(2):530-536.\u003c/li\u003e\n\u003cli\u003eDuran C, Urkmez E, Berker D, et al. Kommerell\u0026apos;s diverticulum in a right-sided aortic arch: a case report and review of literature. Cardiovasc Surg. 2011;25(1):26-29.\u003c/li\u003e\n\u003cli\u003eJanke C, Kausch A, Lange C, et al. Aortic dissection in a patient with Kommerell\u0026rsquo;s diverticulum and right-sided aortic arch. Eur J Cardiothorac Surg. 2015;47(5):864-866.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-cardiovascular-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcar","sideBox":"Learn more about [BMC Cardiovascular Disorders](http://bmccardiovascdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcar/default.aspx","title":"BMC Cardiovascular Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Aortic anomalies, Right-sided aortic arch, Kommerell’s diverticulum, Case report","lastPublishedDoi":"10.21203/rs.3.rs-6727859/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6727859/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction\u003c/strong\u003e: Kommerell's diverticulum with a right-sided aortic arch is a rare congenital anomaly. It may be detected incidentally or present with symptoms due to compression of mediastinal structures. Rarely, it can present with rupture or aortic dissection. Diagnosis is confirmed through computed tomography (CT) or magnetic resonance angiography (MRA). Surgery is typically reserved for symptomatic cases. We report a case of a right-sided aortic arch with aberrant subclavian artery and Kommerell’s diverticulum confirmed by CT in a young woman presenting with chronic cough and retrosternal discomfort.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCase Presentation:\u003c/strong\u003e A 28-year-old woman presented with a 9-month history of dry cough, dyspnea, and dysphagia that began during her third months of pregnancy. Examination revealed differential blood pressures between arms. Chest X-ray showed a right-sided aortic arch displacing the trachea leftward. CT angiography confirmed a right-sided aortic arch with aberrant left subclavian artery originating from a Kommerell’s diverticulum. \u0026nbsp;She was managed symptomatically and remains under follow-up.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e Right-sided aortic arch with Kommerell’s diverticulum may be asymptomatic or present with respiratory and gastrointestinal symptoms. Basic investigations like chest X-ray can aid in early suspicion. It should be considered in the differential diagnosis of chronic cough, dyspnea, and dysphagia.\u003c/p\u003e","manuscriptTitle":"Right-Sided Aortic Arch with Aberrant Left Subclavian Artery–Kommerell’s Diverticulum: a rare case report from Enat Multi specialty clinic, North West Ethiopia, 2025","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-18 19:28:58","doi":"10.21203/rs.3.rs-6727859/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-04T15:09:22+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-25T14:13:14+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-24T14:11:56+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-15T04:19:14+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"260190665338439238207419152839646870429","date":"2025-06-14T10:13:34+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"254381771786205530393661909742774062885","date":"2025-06-12T09:23:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"24174205268637819248388341757955039524","date":"2025-06-12T09:17:30+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-06-12T08:46:17+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-06-02T13:03:05+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-05-30T21:39:22+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Cardiovascular Disorders","date":"2025-05-30T21:36:27+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-cardiovascular-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcar","sideBox":"Learn more about [BMC Cardiovascular Disorders](http://bmccardiovascdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcar/default.aspx","title":"BMC Cardiovascular Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9e1132b5-bcca-41de-ac67-6c6f1c4841e1","owner":[],"postedDate":"June 18th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-24T21:53:16+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-18 19:28:58","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6727859","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6727859","identity":"rs-6727859","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}