University of Missouri Health System Columbia, MO, United States
Mahmoud Mansour, MD1, Harleen K. Chela, MBBS, MD2, Kanak Das, MD3 1University of Missouri Health System, Columbia, MO; 2University of Missouri, Columbia, MO; 3University Medical Center, Lubbock, TX
Introduction: Dysphagia lurosia is a rare condition characterized by impairment of swallowing secondary to extrinsic compression of the posterior part of the esophagus by an aberrant right subclavian artery. Aberrant right subclavian artery, also known as arteria lurosia, is the most common congenital anomaly of the aortic arch with a prevalence of 0.16%-4.4 in the general population.
Case Description/Methods: A 54-year-old previously healthy female presented to the gastroenterology clinic with difficulty swallowing for six months. The patient reported a sensation of food getting stuck in her upper chest and episodes of regurgitation of unswallowed food. Her physical exam and laboratory studies were unremarkable.
A barium esophagogram showed extrinsic compression on the left aspect of the upper esophagus (Figure 1-A). CT angiogram demonstrated an aberrant right subclavian artery compressing the esophagus posteriorly (Figure 1-B,C). EGD revealed a pulsating oblique impression in the left posterior wall of the upper esophagus (Figure 1-D).
The patient was instructed to adopt dietary modifications. However, due to lack of improvement over four months, she opted for vascular reconstruction via a thoracoabdominal approach.
Discussion: Dysphagia lusoria commonly presents during the fourth and fifth decades of life. This late presentation is possibly due to atherosclerotic hardening of the arteries with advancing age. This anomaly is symptomatic in only 30% of patients, with mechanical dysphagia being the most common complaint.
The diagnosis of dysphagia lusoria can be established by a barium esophagogram followed by CT angiography or MR angiography to define the vascular lesion. Upper endoscopy may show a pulsating extrinsic compression of the posterior wall of the esophagus though this finding can be overlooked sometimes. Manometry is usually not helpful in diagnosis.
The management of dysphagia lusoria primarily depends on the severity of symptoms and the impact on nutrition. Non-severe cases can be treated with dietary modification such as eating smaller bites, sipping liquids, and chewing more thoroughly. Surgical interventions with reconstruction of the aberrant vessel might be necessary for intractable cases.
This case highlights the rare condition of dysphagia lusoria. A high index of suspicion is essential for obtaining the right diagnostic workup to establish a diagnosis and manage appropriately.
Figure: Figure 1. (A) Barium esophagogram showing extrinsic impression on the left aspect of the thoracic esophagus (red arrow). (B) Computed tomography (CT) angiography scan showing aberrant right subclavian artery (red arrow) coursing posterior to the esophagus (white arrow) resulting in extrinsic compression. (C) 3-dimensional CT scan showing the heart and aortic arch. The right subclavian artery (highlighted in red) arises as the last branch from the aortic arch distal to the origin of the left subclavian artery. (D) Esophagogastroduodenoscopy (EGD) showing external pulsatile compression of the esophagus.
Mahmoud Mansour indicated no relevant financial relationships.
Harleen Chela indicated no relevant financial relationships.
Kanak Das indicated no relevant financial relationships.
Mahmoud Mansour, MD1, Harleen K. Chela, MBBS, MD2, Kanak Das, MD3. P1430 - Dysphagia Lusoria: A Rare Cause of Dysphagia, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.