University of Iowa Hospitals and Clinics Iowa City, IA, United States
Charles Meade, MD1, Annie Braseth, MD1, Huy Tran, MD, PhD1, Rami G. El-Abiad, MD2 1University of Iowa Hospitals and Clinics, Iowa City, IA; 2University of Iowa Carver College of Medicine, Iowa City, IA
Introduction: We present a case of dysphagia lusoria as well as accompanying findings on barium esophagram, cross-sectional imaging, endoscopy, and high resolution manometry.
Case Description/Methods: A 69 year old male was referred to GI clinic for evaluation of a 4- year history of dysphagia, describing the recurrent sensation of retained food bolus in his throat at a level above the sternal notch. Upper endoscopy revealed LA-B erosive esophagitis and small Schatzki’s ring which was dilated to 19 mm without incident. Further investigation was pursued after endoscopic intervention and PPI therapy did not result in significant clinical improvement.
An esophagram showed oblique extrinsic compression of the mid esophagus at the level of the aortic arch (A, B), and subsequent contrast enhanced CT imaging revealed an aberrant right subclavian artery (C, D). To exclude any underlying intrinsic esophageal dysmotility, the patient underwent high resolution esophageal manometry which showed normal esophageal peristalsis and a pulsatile pressure band in the upper esophagus (E).
Discussion: Dysphagia lusoria was initially reported in 1761 by David Bayford following autopsy findings in a 62 year woman who died of ‘obstructive deglutition’ after a lifelong history of dysphagia. Since Bayford’s original description, aberrant right subclavian artery formation has been identified as a relatively common congenital malformation of the aortic arch, while remaining a less commonly identified cause of dysphagia. While the majority of patients with aberrant right subclavian artery formation are thought to be asymptomatic, patients who seek help can describe dysphagia to solids, chest or thoracic pain with meals, and obstructive symptoms in the upper thorax.
Findings on esophageal manometry are generally nonspecific, although several case reports describe a localized high-pressure zone in the esophagus at the level of the vascular anomaly with accompanying superimposed pulsations. Manometric evidence of vascular compression of the esophageal lumen is traditionally of unclear clinical significance as findings are often discordant with radiographic evidence of mechanical obstruction.
Lifestyle modifications designed to reduce size and improve consistency of the food bolus are typical first line therapy. While perioperative morbidity and mortality has improved dramatically with modern surgical techniques, patients that pursue surgery can experience complete, partial, or no relief of their symptoms post-operatively.
Figure: Figure 1. (A, B) Barium esophagram with evidence of oblique extrinsic compression of the esophagus (C, D) Contrast enhanced CT imaging showing aberrant R subclavian artery with posterior compression of esophagus (E) High resolution esophageal manometry with pulsatile high pressure zone in the upper esophagus
Charles Meade indicated no relevant financial relationships.
Annie Braseth indicated no relevant financial relationships.
Huy Tran indicated no relevant financial relationships.
Rami El-Abiad indicated no relevant financial relationships.
Charles Meade, MD1, Annie Braseth, MD1, Huy Tran, MD, PhD1, Rami G. El-Abiad, MD2. P0333 - Dysphagia Lusoria: Diagnostic Imaging and Manometry Findings in an Unusual Case of Dysphagia, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.