Dannel Diaz Ruiz, MD1, Jan Paul Rosaly, MD2, Miriam Padilla Diaz, MD2, Jeandelize Soto Rosa, MD3 1Mayaguez Medical Center, Mayaguez, Puerto Rico; 2Mayaguez Medical Center, Ponce, Puerto Rico; 3Mayaguez Medical Center, Moca, Puerto Rico
Introduction: An aberrant right subclavian artery that passes dorsally between the esophagus and the spine, causing compression of the esophagus and difficulty swallowing, is termed dysphagia lusoria. This type of extrinsic compression of the esophagus can be seen on barium esophagram, and can be diagnosed by endoscopic ultrasonography or computed tomography (CT) scan.
Case Description/Methods: A 62 years old male with a past medical history of hypertension came to the emergency department after being referred by primary care physician due to progressive dysphagia symptoms. Patient-reported that symptoms started six months ago and are present upon solid food ingestion. Also, he reported feeling a choking sensation after initiating solid food ingestion and accompanied by nausea and episodes of vomiting. He was furthermore presented 40 pounds weight loss in past 6 months. A contrast-enhanced CT scan of the neck with the administration of intravenous iodinated contrast revealed an aberrant right subclavian artery coursing posterior to the trachea and esophagus. A thoracic and bilateral carotids arteriogram revealed the right subclavian artery originating from the aortic arch, distal to the origin of the left subclavian artery arising from a prominent aortic arch diverticulum at the proximal descending aorta. The patient underwent a right carotid to subclavian bypass and ligation of an aberrant right subclavian artery proximal to the right vertebral artery. The patient tolerated the procedure without any complications and was successfully discharge with the resolution of symptoms and nutritional status.
Discussion: An aberrant subclavian artery prevalence in the general population is estimated at 0.4% to 1.8%. Out of this group of aberrant anatomy, reports demonstrate just that right subclavian artery arising from the distal pattern of the aortic arch as its last branch occurs in 0.4 and 2% of individuals. Patients who fail to diet modifications usually undergo surgical, vascular reconstruction. While dysphagia lusoria is rare, it is essential to understand and identify such conditions to assist in the early diagnosis and prognosis of such patients.
Reference:
De Luca L, Bergman JJ, Tytgat GN, Fockens P. EUS imaging of the arteria lusoria: case series and review. Gastrointest Endosc 2000; 52:670.
Febrero B, Ríos A, Rodríguez JM, Parrilla P. Dysphagia lusoria as a differential diagnosis in intermittent dysphagia. Gastroenterol Hepatol 2017; 40:354.
Figure: thoracic and bilateral carotids arteriogram revealing the right subclavian artery originating from the aortic arch, distal to the origin of the left subclavian artery arising from a prominent aortic arch diverticulum at the proximal descending aorta.
Disclosures: Dannel Diaz Ruiz indicated no relevant financial relationships. Jan Paul Rosaly indicated no relevant financial relationships. Miriam Padilla Diaz indicated no relevant financial relationships. Jeandelize Soto Rosa indicated no relevant financial relationships.
Dannel Diaz Ruiz, MD1, Jan Paul Rosaly, MD2, Miriam Padilla Diaz, MD2, Jeandelize Soto Rosa, MD3. P0372 - An Unusual Case of Dysphagia Lusoria Arising from the Distal Pattenr of Aortic Arch, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.
