A 62-year-old male presented to the outpatient department of chest with history of dry cough since two months and swelling on the anterior aspect of neck of 30-year duration. the LGD1069 symptom. Vascular anomalies such as Kommerell’s diverticulum though uncommon should be considered in the differential diagnosis of chronic cough particularly when other common causes have been ruled out. 1 Introduction Burckhard Kommerell described an aortic diverticulum for the first time in 1936 in a living patient [1]. This saccular aneurysmal dilation at the origin of aberrant subclavian artery consists of an aneurysm of the thoracic aorta as well as an aneurysmal opening of an aberrant subclavian artery [2 3 It is an uncommon condition that occurs in association with a left aortic arch with aberrant right subclavian artery (prevalence of 0.5%-2.0%) or a right aortic arch with aberrant left subclavian artery (0.05%-0.1%) [3]. We present one such case of Kommerell’s diverticulum that presented in an unusual way. Symptomatic Kommerell’s diverticulum usually manifests with chest symptoms or dysphagia. In this particular case the patient presented with an uncommon manifestation in the form of chronic cough. 2 Case Report A 62-year-old man presented to the outpatient department of chest with history of insidious onset of dry cough of two-month duration. He also had a swelling on the anterior LGD1069 aspect of his neck since the past 30 years. There was no history of stridor breathlessness dysphagia nasal symptoms heartburns or any constitutional symptoms. Review of his medical records revealed that he had been prescribed inhaled steroids bronchodilators antihistaminics and proton pump inhibitors for the treatment of his cough but he was not relieved of his symptom. He did not smoke or consume alcohol. On general physical examination patient was moderately built and nourished afebrile with a pulse rate 75/min regular and good volume respiratory rate 14/min and blood pressure 128/86?mm?Hg. There was a firm nontender swelling of 8?cm × 7?cm size LGD1069 on the anterior aspect of the neck which moved with deglutition. The skin over the swelling was normal. There was no significant lymphadenopathy. Chest examination was normal. The otorhinolaryngological LGD1069 (ENT) evaluation was also normal except for the presence of diffuse enlargement of thyroid gland which was nonpulsatile. Examination of abdomen and other systems did not reveal any abnormality. The patient’s serology was negative for retrovirus. Hemogram blood biochemistry serum electrolytes and thyroid function tests were within normal limits. The Mantoux test showed no induration. Routine urine analysis was normal. Three induced-sputum sample smears were negative for acid fast bacilli. Fine needle aspiration and cytology of the thyroid demonstrated the presence of a colloid goitre. Pulmonary function testing did not show any evidence of reactive airway disease but instead was suggestive of variable intrathoracic airway obstruction. Frontal view of the chest roentgenogram showeda right-sided aortic archand alsothyroid enlargement (Figure 1). Computed tomography (CT) of thorax revealed (Figures ?(Figures22 and ?and3)3) the presence of a right-sided aortic arch with aberrant left subclavian artery showing Kommerell’s diverticulum at its origin as well as the tracheal narrowing between the arch of the aorta and the Kommerell’s diverticulum. Fiberoptic bronchoscopy did not reveal any abnormality except LGD1069 for compression of the trachea corresponding to the site of anomaly. Figure 1 Frontal chest radiograph shows evidence of right-sided aortic arch (open arrow) and also a soft-tissue density in the neck representing thyromegaly (solid arrow). Figure 2 Coronal reconstruction (a) and volume-rendered (b) images of thorax demonstrate right-sided Rabbit Polyclonal to Gastrin. aortic arch with aberrant left subclavian artery (arrow) showing Kommerell’s diverticulum (open arrow) at its origin. Figure 3 Contrast-enhanced computerized tomogram of thorax demonstrating trachea LGD1069 (curved solid arrow) narrowed between the arch of the aorta and the Kommerell’s diverticulum (arrow). 3 Discussion In patients with a right aortic arch Kommerell’s diverticulum is an embryologic remnant of the left fourth aortic arch posteriorly. Though the diverticulum can present with chest symptoms or dysphagia it may not always cause symptoms [1 3 The enlargement of the Kommerell’s diverticulum by itself and the sling-like effect of the left subclavian artery which.