An asymptomatic double aortic arch with separate right vertebral artery and left subclavian artery originating from Kommerell diverticulum combined with congenital asplenia and absence of celiac trunk.

This report describes the unique case of a completely patent Double Aortic Arch (DAA) combined with Kommerell diverticulum (KD), absence of celiac trunk, and congenital asplenia. The anatomical variants described were identified and assessed in a 51-year-old female from computed-tomography angiography (CTA) images with 3D-volume rendered reconstructions during her follow-up after hysterectomy. The reconstructed CTA images showed a DAA with the left common carotid artery stemming from the hypoplastic left aortic arch while the left subclavian artery originated from a KD in the descending thoracic aorta. A symmetric arrangement of the aortic arch branches was demonstrated, comprising a full vascular ring. Since the patient had been completely asymptomatic and with no symptoms of compression of the oesophagus or trachea, no surgical management was advised. The abdomen CTA imaging revealed absence of the celiac trunk with direct origin of the common hepatic and the left gastric artery from the superior mesenteric artery as well asplenia. The authors present a case of asymptomatic DAA of completely patent arches with the right vertebral artery branching separately of and the left SCA originating from KD in the descending aorta. The term KD can be identified also in arch anomalies other than the one originally described. Because anatomical anomalies can frequently be combined, thorough imaging inspection with CTA of both the thorax and abdomen is suggested.