# Ligamentum Arteriosum Calcification Associated With Kommerell Diverticulum Mimicking a Foreign Body in the Esophagus: A Case Report

## TL;DR

A child's pharyngeal discomfort was initially thought to be esophageal perforation, but was actually due to a calcified ligamentum arteriosum associated with a Kommerell diverticulum.

## Contribution

This case report highlights a rare anatomical condition that can mimic esophageal perforation on imaging, emphasizing the need for accurate diagnosis.

## Key findings

- A high-density mediastinal shadow was initially suspected as esophageal perforation but was later identified as ligamentum arteriosum calcification.
- The absence of inflammatory signs and accurate CT interpretation helped avoid unnecessary invasive procedures.

## Abstract

Esophageal perforations caused by a foreign body are a serious condition requiring urgent intervention due to the risk of severe mediastinitis. However, certain calcified anatomical structures may be misdiagnosed as a foreign body owing to the similarities of the features on imaging studies. We herein report the case of a seven-year-old female patient who presented with persistent pharyngeal discomfort after ingesting skewered beef containing bone fragments. Initial computed tomography (CT) at the previous hospital revealed a high-density mediastinal shadow, which raised suspicion of an esophageal perforation. Further evaluation at the study center identified a right aortic arch with a Kommerell diverticulum and a linear, high-density lesion between the diverticulum and the pulmonary artery in the area corresponding to the ductus arteriosus. In the absence of inflammatory signs, the lesion was diagnosed as ligamentum arteriosum calcification associated with a vascular ring. The patient was managed conservatively and discharged without complications. This case highlights the importance of recognizing that ligamentum arteriosum calcification can mimic esophageal perforation. Assessing whether the symptoms correlate with mediastinitis due to an esophageal perforation, along with the accurate interpretation of CT findings, including the anatomical location of the lesion and the absence of inflammatory signs, was crucial to avoid unnecessary invasive procedures.