Major Positional Obstruction of the Trachea in a Patient With a Right-Sided Aortic Arch and Kommerell’s Diverticulum

TRACHEAL COMPRESSION in patients with a right-sided aortic arch and Kommerell’s diverticulum (classically defined as a bulbous configuration of the origin of an aberrant left subclavian artery in the setting of a right-sided aortic arch) previously has been described. In reported cases, clinically significant tracheal compression was noted preoperatively or soon after induction of anesthesia but prior to any change in the position of the patient. There has not been a case report in a patient with a right-sided aortic arch and Kommerell’s diverticulum in whom tracheal compression and/or obstruction was related only to surgical positioning and was otherwise absent. This case report describes a patient with a right-sided aortic arch and Kommerell’s diverticulum without any clinically significant symptoms during normal daily activities, exercise, or while sleeping in supine, lateral, or prone positions. Following tracheal intubation under general anesthesia in the supine position, no tracheal compression or difficulty with mechanical ventilation was encountered. However, complete tracheal obstruction was manifested in the right lateral decubitus position after placement of an axillary roll. This compression was relieved completely when the axillary roll was removed and the patient was returned to the supine position.