First MDCT evidence of ruptured aberrant left subclavian artery aneurysm in right aortic arch, Kommerell's diverticulum and extrapleural hematoma treated by emergency thoracic endovascular aortic repair

Spontaneous ruptured aneurysm involving an aberrant subclavian artery with a right-sided aortic arch and Kommerell's diverticulum is a rare life-threatening condition that can be treated successfully if promptly identified. Multidetector Computed Tomography angiography is the first line imaging modality of thoracic vascular anomalies diagnosis. We report the case of a 74-year-old man suffering from this emergency condition with mediastinal hematoma mostly extending to the left-side extrapleural cavity. The patient underwent successful emergency thoracic endovascular aortic repair and an Amplatzer vascular plug was placed into the first segment of the ALSA. Post-procedural imaging showed complete exclusion of the aneurysm. Emergency endovascular repair can be effective in such cases.