What is kommerell diverticulum? - Symptoms, Causes, Repair, CPT & ICD-10

A condition known as Kommerell's diverticulum is characterized by an aneurysmal dilatation of the descending aorta at the base of an irregular subclavian artery. This condition can occur on either the right or left side of the aortic arch. In radiographic studies, the incidence of a Kommerell's diverticulum in conjunction with a right-sided aortic arch ranges from 0.05% to 0.1%. This congenital defect is extremely uncommon.

In 1936, German radiologist Kommerell was the first to describe it. Initially, he described a pulsating mass behind the esophagus that was compressing it during a barium swallow in a patient with a left-sided aortic arch. There are a few other names for Kommerell's diverticulum, including "lusoria diverticulum," "remnant diverticulum," and "lusoria root."

The Kommerell diverticulum (KD) is an exceptionally rare aortic developmental anomaly associated with an irregular subclavian artery (ASCA).

Kommerell Diverticulum Symptoms

A Kommerell diverticulum is a rare aortic arch defect that can compress neighboring tissues, such as the esophagus and trachea. Wheezing, coughing, persistent tracheobronchial infections, dysphagia, breathlessness, stridor, dyspnea, and even asthma-like complaints are all signs of Kommerell diverticulum. In some instances, the abnormality might create a partial vascular ring around the trachea and esophagus, resulting in dyspnea, wheezing, and dysphagia. In order to relieve compression on the surrounding structures, Kommerell diverticulum treatment usually entails surgical dilatation.

Kommerell Diverticulum Causes

A pouch-like enlargement of the aorta wall, known as a Kommerell diverticulum, is the result of a congenital malformation of the aortic arch. Though its specific source is uncertain, the Kommerell diverticulum is thought to be the consequence of a developmental anomaly that takes place during the growth and development of the fetus. Possible contributing causes include genetic abnormalities, the irregular blood supply in the aorta, and deformities of the tissues that comprise the aortic wall.

Kommerell Diverticulum Repair

In order to remove the diverticulum and restore the normal aortic structure, Kommerell diverticulum repair often entails surgical intervention. Depending on the circumstances of each case, a particular surgical approach might be used, such as open surgery or minimally invasive endovascular techniques. The extent of the diverticulum, its location, any accompanying conditions, and the patient's general health all play a role in the likelihood of a successful repair.

Standard repair of a Kommerell diverticulum involves thoracotomy and in situ reconstruction of an abnormal subclavian artery. Other methods involve oversewing the right arch, reattaching the LSCA, and performing a hybrid repair that entails removing the ring and inserting an ascending-to-distal aortic graft. Kommerell diverticulums are prone to rupture and need a one-stage hybrid repair in some situations.

Kommerell Diverticulum CPT

The precise procedure carried out will determine the CPT code for Kommerell diverticulum repair. Common codes are 33880, which describes the repair of the vascular ring in conjunction with the resection of Kommerell's diverticulum, and 35621, which describes the repair of Kommerell's diverticulum in conjunction with an irregular subclavian artery.

Kommerell Diverticulum ICD-10

A Kommerell diverticulum is an aortic arch developmental defect defined by a diverticulum at the proximal descending aorta. The ICD-10 code for this condition is Q25.4, and it can be further described with the codes Q25.47 for the right aortic arch and Q25.49 for additional congenital abnormalities of the aorta.